Provider Network Consultant - Lancaster, PA

Company: Humana
Location: Lancaster, PA
Employment Type: Full Time
Wage: yearly

Humana Inc., headquartered in Louisville, Kentucky, is one of the nation's largest publicly traded health benefits companies. Humana offers a diversified portfolio of health insurance products and related services - through traditional and consumer-choice plans - to employer groups, government-sponsored plans, and individuals.

Today, Humana is a leader in consumer engagement. Throughout its diversified customer portfolio, the company provides guidance that can both help lower costs and lead to a better health plan experience.

Role: PNO Consultant
Assignment: Senior Products
Location: Lancaster, PA

Are you a fit?
Do you enjoy building relationships with providers? Would you like to represent a Fortune 100 leader in the Healthcare Industry? If so, this role may be for you:

The Provider Network Consultant will be Humana's liaison with all providers (doctors, hospitals, ancillary providers) in a designated geographic area. This position is responsible for providing value added communications and services to Humana's provider partners. On an ongoing basis will manage and direct the entire provider relations process. Will educate and support providers regarding Humana's Medicare Advantage plan operations and issues through telephonic contact, individual meetings and group seminars. Will provide world-class education/training to our provider partners by working with medical affairs to resolve member service issues; working with the claims processors to resolve claims issues; developing provider relations plans; and communicating reimbursement logic to providers. Will cultivate relationships with providers in the designated area to ensure accomplishment of departmental and corporate goals.

Role Requirements:

  • Bachelors Degree
  • Ability to work with both large and individual provider groups, as well as with people from internal areas that support the process.
  • Strong communicator, including presentation and negotiation skills to create a win-win environment.
  • Strong investigative, analytical and complex decision making skills.
  • Accuracy and attention to detail is critical.
  • Creativity and innovation in working with providers and implementing new products. Ability to obtain knowledge by asking questions, exploring different options, being creative, thorough and open to new ideas.
  • Well-developed planning, organizational and extensive follow-up skills are critical.
  • Strong Project Management skills
  • Ability to work without close supervision.

Role Desirables:
  • 5 years medical/insurance industry experience (experience in similar industry may be substituted)
  • 3 years experience in a claims processing/customer service or billing and enrollment/market staff support environment with strong knowledge of system processing, problem solving and Medicare products.

Additional Information
The ideal candidate will have a strong interest in customer service, excellent problem solving skills and strong computer skills. Understanding of provider office/IPA concerns is a major plus. This position requires a broad knowledge of Medicare plan designs, claims processing, customer service, enrollment, electronic claims transfer, networks and system capabilities. This position will require 70% daily travel.

Job Code: 46365
Category: Health Care
Post Date: Monday, August 29, 2011 at 5:01 AM
Company: Humana
Contact Name:

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