Humana Provider Contracting Representative - Pinellas/Pasco County, FL in Clearwater, Florida

Role:Provider Contracting Representative

Assignment:Humana Long-Term Care

Location:Work-At-Home - Pinellas/Pasco County, FL

We’re looking for associates who are dedicated to service and believe in following the Golden Rule of treating others the way you want to be treated. Humana was founded on this premise, and this value is reflected in our expectations for providing perfect service to our providers, consumers, employers, agents and others we work with. At Humana, Perfect Service® means getting the basics done right, delivering value and quality, and providing everyone with personalized attention and guidance. We want to engage with our members through every step of their journey to lifelong well-being. This includes meaningful direct consumer interaction and developing positive relationships with healthcare providers. Humana associates provide Perfect Service every day to our providers, members, employers, and colleagues. We’re looking for people who improve their own well-being by looking out for the best interests of others.

Assignment Capsule

Be part of the Provider Contracting world at Humana where you will help maintain a competitive network for our members.

Humana Long-Term Care is seeking a Provider Contracting Representative who will establish and maintain a network of licensed and compliant providers that meet the skilled and unskilled service needs of the member population in Region 5 (Pinellas and Pasco County, FL).

Job Functions

  • Evaluates member service needs reports to ensure that there are sufficient providers contracted to meet member care needs.

  • Negotiates and maintains contractual relationships with vendors in areas of service needs.

  • Updates and maintains network tracking systems on the current status of pending and renewing vendor applications.

  • Regularly communicates with the Care Management team on Provider Relations updates and issues.

  • Serves as an educator/liaison with providers to ensure providers are current on Statewide Medicaid Managed Care (SMMC) programs, policies & procedures, billing practices, accessibility standards and contracted service requirements.

  • Responds to corporate office requests to obtain updated status on pending contracts and outstanding documentation and/or compliance issues.

  • Attends trade organization events, conferences and business networking meetings on a regular basis.

  • Consistently meets established productivity.

Role Essentials

  • High School Diploma or equivalent.

  • One to three years related experience.

  • Knowledge of Microsoft Office programs.

  • Must possess strong communication skills, both verbal and written.

  • Excellent interpersonal skills.

  • This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

  • 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.

  • Must have a separate room with a locked door that can be used as a home office to ensure you have absolute and continuous privacy while you work.

  • Must have accessibility to high speed DSL or Cable modem for a home office (No Satellite).

  • AHCA Fingerprint Required.

Role Desirables

  • Associates or a Bachelors Degree.

  • Three years healthcare industry experience working in Provider Relations.

  • Knowledge of Long Term Care Manage Care Plan.

Additional Information

Humana is an organization with careers that change lives—including yours. As an innovator in the fast-paced industry of healthcare, we offer our associates careers that challenge, support and inspire them to use their passion for helping others and to lead their best lives. If you’re ready to help people achieve lifelong well-being, and be a part of an organization that is growing and poised to make an impact on the future of healthcare, Humana has the right opportunity for you.

Interview Format

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence(please be sure to check your spam or junk folders often to ensure communication is not missed)inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Title: Provider Contracting Representative - Pinellas/Pasco County, FL

Location: FL-Clearwater

Requisition ID: 181677

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.

Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. We also provide free language interpreter services. See our full accessibility rights information and language options.