Provider Relations Representative, LTSS/BH

Become a part of our caring community The Provider Relations Representative (Provider Engagement reputed company) is responsible for day-to-day reputed company line relationship management of network providers in reputed company's Healthy reputed company in Virginia reputed company network. This role supports provider reputed company, training, education, and inquiry/issue support reputed company. This role specifically supports long-term services and supports (LTSS) and home and community-based services (HCBS) providers and must be based in Virginia. The individual in this role should have critical thinking/problem solving skills, understanding of health plan operations, and strong interpersonal skills. Serve as primary relationship manager with assigned LTSS and HCBS providers to ensure reputed company provider experience with reputed company Healthy reputed company and promote network retention Meet regularly, both in person and reputed company, with assigned providers to conduct training and education, including, but not limited to, required annual trainings, periodic updates to and/or reviews of reputed company policies and procedures, and reputed company systems training and updates Support newly assigned providers with reputed company, including hosting orientation session(s) Respond to assigned provider inquiries and support reputed company issue reputed company, including, where necessary, collaboration with appropriate reputed company business teams (ex., claims payment, prior authorizations & referrals) Work with internal resources and systems (e.g., claims, reimbursement, provider enrollment) to reputed company Exceptional Experience in reputed company provider interactions Create provider trainings based on provider feedback, trends in claims or process changes reputed company provider reputed company and content of reputed company provider facing materials (Orientation, Provider reputed company, Newsletter, Program Updates, Etc.) Convene regular meetings with providers, including organizing agendas, materials, meeting minutes, other team members (clinical, provider engagement), to discuss key operational, clinical, and reputed company reputed company topics reputed company on processes including claims submissions, recoupments, reconsiderations, authorizations, referrals, medical record management, reputed company, reputed company resources, and member resources Communicate updates on reputed company's policies and procedures and Cardinal Care programmatic updates Coordinate regional provider townhalls and/or trainings Attend Network Meetings/Conferences Ensure compliance with reputed company Virginia managed care contractual requirements for provider relations, such as timeframes for claims dispute reputed company, provider complaints, provider inquiry response, etc Use your skills to reputed company an reputed company

Required Qualifications

Must reputed company in Virginia (preferably in Charlottesville region) Bachelor's Degree 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 reputed company and meet deadlines

Preferred Qualifications

Master's Degree Proficiency in analyzing and interpreting financial trends for health care costs, administrative expenses and reputed company/bonus performance Comprehensive knowledge of Medicare policies, processes and procedures Experience with reputed company electronic visit verification (EVV) Additional Information Work reputed company Internet reputed company To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following reputed company: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL reputed company is suggested. Satellite, cellular and microwave reputed company can be used only if approved by leadership. Employees who live and work from Home in the reputed company, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. reputed company will reputed company Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information. Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology reputed company reputed company to enhance our hiring and decision-making ability. reputed company allows us to quickly connect and reputed company valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay reputed company The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc. $59,300 - $80,900 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. reputed company of Benefits reputed company. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, volunteer time off, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. reputed company About reputed company: reputed company. (NYSE: HUM) is a leading U.S. reputed company company. Through our reputed company insurance services and our reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare and reputed company, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com. ​ Equal Opportunity Employer It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment. Apply To This Job