Senior Market Development Professional

About the position

Humana Gold Plus Integrated is seeking a Senior Market Development Professional who serves as the front-line representative for the Long-Term Services & Support (LTSS)/Long Term Care (LTC) providers for the Illinois Medicare - Medicaid Alignment Initiative (MMAI) plan. The Senior Market Development Professional's work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors to provide optimal provider services. This role is crucial in ensuring that providers have a positive experience with Humana's IL MMAI plan and in promoting network retention. The Senior Market Development Professional will serve as the primary relations manager with LTSS, Skilled Nursing Facilities, HCBS providers, and/or PH providers. This includes developing and maintaining provider relationships to optimize provider experience and satisfaction, which involves face-to-face visits with providers. The professional will also support newly assigned providers with onboarding, including conducting orientation sessions. Additionally, they will respond to provider questions or inquiries, ensuring prompt resolution to provider issues with appropriate enterprise business teams, including those associated with claims payment, prior authorizations, and referrals, while providing education about participation in Humana's IL MMAI plan. Regular meetings (both virtual and potentially in-person) with assigned providers will be conducted to provide training and education. The Senior Market Development Professional will communicate Humana's policies and procedures and coordinate provider training and orientation sessions. They will also make decisions on moderately complex to complex issues regarding the technical approach for project components, performing their work without direct supervision. This position requires a proactive approach to managing relationships and ensuring that providers are well-informed and satisfied with their interactions with Humana.

Responsibilities
? Serve as primary relations manager with LTSS, Skilled Nursing Facilities, HCBS providers, and/or PH providers to ensure a positive provider experience with Humana IL MMAI plan and promote network retention.
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? Develop and maintain provider relationships to optimize provider experience and satisfaction, including face-to-face visits with providers.
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? Support newly assigned providers with onboarding, including orientation session(s).
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? Respond to assigned provider questions or inquiries, ensuring prompt resolution to provider issues with appropriate enterprise business teams.
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? Meet regularly (virtually and potentially in person) with assigned providers to conduct trainings and education.
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? Communicate Humana's policies and procedures and coordinate provider training and orientation sessions.
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? Make decisions on moderately complex to complex issues regarding technical approach for project components, working without direction.

Requirements
? Must reside in the eastern standard or central standard time zone in the United States.
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? Bachelor's Degree OR 4+ years of equivalent experience (4 years of relevant experience in managed care and/or provider engagement).
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? 2+ years of progressive experience in provider relations.
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? Working knowledge and experience with IL Dual Demonstration and/or LTSS-Medicaid.
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? Experience with claims systems, adjudication, submission processes, coding, and/or dispute resolution.
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? Advanced knowledge of provider network operations tools, processes, and best practices.
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? Proficiency in analyzing, understanding, and communicating complex issues, along with the ability to facilitate meetings with diverse audiences.
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? Ability to manage and prioritize multiple projects in a fast-paced environment to achieve results.

Nice-to-haves
? Some experience working with facilities and ancillary providers, and/or FQHCs.
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? Thorough understanding of managed healthcare contracts, including provider contract language and reimbursement.
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? Strategic thinker with the ability to work independently.
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? Prior process creation or improvement experience.
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? Proficient in MS Office Applications including Microsoft Project, SharePoint, Teams, MS Word, PowerPoint, Outlook, and Excel.

Benefits
? Medical, dental and vision benefits
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? 401(k) retirement savings plan
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? Paid time off, including company and personal holidays
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? Volunteer time off
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? Paid parental and caregiver leave
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? Short-term and long-term disability
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? Life insurance
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? Many other opportunities

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