Provider relations specialist job description

The Provider Relations/Engagement Professional 2 develops and grows positive, long-term relationships with physicians, providers and healthcare systems in order to support and improve financial and quality performance within the contracted working relationship with the health plan. The Provider Engagement Professional 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.
Responsibilities

The Provider Relations/Engagement Professional 2 will be responsible for:

Visiting w/Provider face to face and virtual, educating providers on policies and processes, building relationships, educating providers on the use of online tools and resources, monitoring reports and documenting provider encounters Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Must be passionate about contributing to an organization focused on continuously improving consumer experiences Follows established guidelines/procedures.

Required Qualifications
1 - 5 years of Health care or managed care with Provider Contracting, Network Management or Provider Relations experience Proven planning, preparation and presenting skills, with established knowledge of reimbursement and bonus methodologies Demonstrated ability to manage multiple projects and meet deadlines Intermediate to advanced computer skills and experience with Microsoft Word, Excel, Outlook and Power PointStrong verbal and written communication skills Strong organization and prioritization skills Experience working with Providers Office, Hospitals, Conferences, Seminars, Town Halls and other community based events Humana and its subsidiaries require vaccinated associates who work outside of their home to submit proof of vaccination, including COVID-19 boosters. Associates who remain unvaccinated must either undergo weekly negative COVID testing OR wear a mask at all times while in a Humana facility or while working in the field. Must be available to work a flexible schedule for Association Events otherwise the schedule will be Monday - Friday and require a minimum of 3-4 days travel a week in your local area Training date 10/10/22

Work-At-Home Requirements

Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense.A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role.A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Travel
This position will require a minimum of 3-4 days a week in your local area - New Orleans and Baton Rouge areas Must have a Valid driver's license with reliable transportation and the ability to travel within the state, as required This role is part of Humana's Driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,000 limits.

Preferred Qualifications
Experience with Physical or Behavioral HealthWorking with Louisiana MedicaidComprehensive knowledge of Medicaid policies, processes, and procedures

Additional Information

Section 1121 of the Louisiana Code of Governmental Ethics states that current or former agency heads or elected officials, board or commission members or public employees of the Louisiana Health Department (LDH) who work directly with LDH's Medicaid Division cannot be considered for this opportunity. A separation of two (2) or more years from LDH is required for consideration. For more information please visit: Louisiana Board of Ethics (la.gov)

#LI-KK1 #LouisianaMedicai

Scheduled Weekly Hours

40

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: Serve as a liaison between providers, the health plan and Corporate to investigate and resolve provider claims

• Conduct on-site provider orientations, including writing and updating orientation materials and assisting providers acclimated to plan website
• Monitor financial performance of contracts

• Investigate and document provider changes and correspondence

• Coordinate with credentialing to ensure all appropriate documentation is received

• Serve as a lead for key special projects

• Recommend changes in pricing subsystems

• Coordinate printing of provider directories with corporate and plan level entities

• Investigate and respond to complex provider related issues and initiate change of provider related database information

• Serve as a subject matter expert for provider relations activities and as a mentor for Provider Relations Specialist I staff

• Ability to travel

Education/Experience: High school diploma or equivalent. Bachelor's degree in healthcare related field preferred. 5+ years of sales, provider relations, or contracting experience. Claims processing and/or managed care experience preferred. Driver's License may be required by some plans. Specific language skills may be required by some plans.

License/Certification: Valid driver's license.

For Fidelis Care only: Must have valid driver license, personal vehicle and ability to travel.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

**TITLE:** Provider Relations Specialist II

**LOCATION:** Little Rock, Arkansas

**REQNUMBER:** 1355567

* Directs the deployment of security infrastructure.
* Directs the agency risk management program through planning, developing, coordinating, and implementing information technology disaster recovery and business continuity planning.
* Directs and/or conducts research related to security trends and technology.
* Oversees the implementation of computer system security plans with agency personnel and outside vendors.
* Oversees the ongoing development and implementation of state-wide information and cybersecurity policies, standards, guidelines, and procedures to ensure information security capabilities cover current threat capabilities.
* Develops and implements agency policies for encryption of data transmissions and the erection of firewalls to conceal information as it is being transmitted and to eliminate tainted digital transfers.
* Develops and manages information security and risk management awareness and training programs.
* Reviews technical risk assessments and new and existing applications and systems, including data center physical security and environment.
* Reviews results of special investigations, internal audits, research studies, forecasts, and modelling exercises to provide direction and guidance.
* Reviews guidelines, procedures, rules, and regulations; and monitors compliance

Minimum Requirements:

* Information security operations, information technology, and/or information security analysis management work.
* State of Texas information security operations and/or information technology experience;
* Certified Information Systems Security Professional (CISSP), Certified Cloud Security Professional (CCSP) certification, and/or Certified Information Systems Manager (CISM)

OTHER SPECIAL REQUIREMENTS: -Minimum Qualifications

* Graduation from an accredited four-year college or university with a degree in information technology security, computer information systems, computer science, management information systems, or a related field; and
* Five (5) years of experience in information security operations, information technology, and/or information security analysis management work.

Preferred Qualifications

* Three (3) years of state of Texas information security operations and/or information technology experience; and
* Certified Information Systems Security Professional (CISSP), Certified Cloud Security Professional (CCSP) certification, and/or Certified Information Systems Manager (CISM).
* Advanced knowledge of local, state, and federal laws and regulations relevant to information security, privacy, and computer crime (Texas Administrative Code Chapter 202, Texas DIR Security Controls Standards Catalog, TX-RAMP/Fed-RAMP).
* Advanced knowledge of the principles and practices of public administration and management.
* Advanced knowledge of the limitations and capabilities of computer systems.
* Advanced knowledge of technology across all network layers and computer platforms.
* Advanced knowledge of operational support of networks, operating systems, Internet technologies, databases, and security applications.
* Advanced skills in cyber analytics, risk analysis, planning, process design and auditing.
* Skill in the use of a computer and applicable software.
* Skill in configuring, deploying, and monitoring security infrastructure.
* Ability to direct and organize program activities.
* Ability to analyze complex information and exercise sound judgment in making critical decisions or providing recommendations to agency management that lead to critical decisions.
* Ability to identify problems, evaluate alternatives, and implement effective solutions.
* Ability to develop, evaluate and write policies and procedures.
* Ability to prepare reports.
* Ability to respond to and resolve advanced security issues in a decentralized environment.
* Ability to communicate effectively, including translating complex technical information into non-technical, clear concepts, both orally and in writing.