Senior Provider Relations Professional (SC Medicaid)



The Senior Provider Relations Professional is responsible for day to day front line network provider relationship management for Humana’s South Carolina Medicaid plan through provider contracting, provider training, education, and provider relations. Work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. Exercises independent judgement and works under minimal supervision.


Key Role Objectives

* Develop and maintain provider relationships to optimize provider engagement, performance and satisfaction.
* Ensure prompt resolution of provider inquiries or concerns and appropriate education about participation in Humana’s South Carolina Medicaid plan.
* Communication of Humana’s policies and procedures and provider training/orientation materials.
* Participate in provider training and provider orientation sessions.
* Execute on Humana’s South Carolina provider network development strategies to ensure a sufficient network for meeting the health care needs of Humana’s South Carolina Medicaid plan members. This will include provider contracting.
* Work with internal corporate partners to ensure cross-department communication and resolution of provider’s issues.
* Work with internal resources to provide the Perfect Experience in all provider interactions (e.g. claims, reimbursement, and provider enrollment/credentialing) with Humana’s South Carolina Medicaid plan.

Required Qualifications

* Bachelor’s Degree
* 4 or more years of progressive experience in managed care operations and provider relations
* Exceptional relationship management skills
* Excellent written and verbal communication skills
* Proficiency in analyzing, understanding, and communicating complex issues
* Thorough understanding of managed care contracts, including contract language and reimbursement
* Ability to manage multiple priorities in a fast-paced environment
* Knowledge of Microsoft Office applications
* Must be passionate about contributing to an organization focused on continuously improving consumer experiences
* Must reside in South Carolina

Preferred Qualifications

* Master’s Degree
* Experience with the South Carolina Medicaid

Additional Information

This position will be “work at home”, however, you will be required to travel to provider offices within the South Carolina Market up to 50% of the time.

Associate must reside in South Carolina.

Scheduled Weekly Hours



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