Role: Provider Education Relations Representative Assignment: Humana Government Business *Location: Work at Home - but must live within a 45 minute commute of the Millington, TN area. *
Establish and maintain an appropriate and viable network of providers throughout their Prime Service Areas (PSAs). Target providers for inclusion in the network based on network development strategy and complete contracts including the negotiation of discount rates. Provide ongoing education and other assistance to providers to facilitate proper utilization and claims payment.
Provide appropriate education to contract providers and their staffs within required time frames and in accordance with HUMANA GOVERNMENT BUSINESS contract standards.
Develop and maintain a high-quality, cost effective network of providers, which meets TRICARE beneficiary, needs and HUMANA GOVERNMENT BUSINESS contract requirements.
Solicit and promote use of Web technology and EMC for providers in their PSAs.
Develop preferred provider strategy and guidelines to foster optimum steerage of beneficiaries to appropriate network providers and facilities.
Assist network providers with billing and claims issues as needed. Provide timely follow-up to provider inquiries and facilitate resolution of issues.
Submission of accurate and complete initial credentialing and contract packages. Do necessary follow-ups to insure recredentialing issues are resolved in a timely manner.
Role Essentials * Our Department of Defense Contract requires U.S. citizenship for this position.
Bachelor's Degree or 1 - 2 years of equivalent business, contracting, customer relations and/or TRICARE experience
One or two years experience in a medical environment dealing with managed care or insurance issues (i.e. benefits, claims, etc.)
Strong written communication
Strong PC skills, including business software
Must be self-motivated, detail oriented and able to prioritize workload
Successfully receive interim approval for government security clearance (eQIP - Electronic Questionnaire for Investigation Processing) Role Desirables
Previous experience in provider contracting or provider services
Knowledge of the TRICARE program
Title: Provider Education Relations Rep - Millington TN
Requisition ID: 192540
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.