Senior Market Development Professional

Become a part of our caring community and help us put health firstHumana 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 work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors to provider optimal provider services.The Senior Market Development Professional typical role and responsibilities, but not limited to:

Serves as primary relations manager with LTSS, Skilled Nursing Facilities, HCBS providers and/or PH providers to ensure positive provider experience with Humana IL MMAI plan and promote network retention.

Develops and maintains provider relationships to optimize provider experience and satisfaction, including face to face visits with providers.

Supports newly assigned providers with onboarding, including orientation session(s).

Responds to assigned provider questions or inquires, and if necessary, ensures prompt resolution to provider issues with appropriate enterprise business teams, including those associated with claims payment, prior authorizations, and referrals, as well as appropriate education about participation in Humana's IL MMAI plan.

Meets regularly (virtually and potentially in person) with assigned providers to conduct trainings and education.

Communicates Humana's policies and procedures and provider training/orientation materials and coordinates provider training and provider orientation sessions.

Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction.

Use your skills to make an impactRequired Qualifications

Must reside in the eastern standard or central standard time zone in the United States.

Travel required for this role - approximately 20% travel across the state of Illinois to visit provider offices and Humana locations (travel may include overnight stays).

Bachelor's Degree OR 4+ years of equivalent experience (4 years of relevant experience in managed care and/or provider engagement).

2+ years of progressive experience in provider relations.

Working knowledge and experience with IL Dual Demonstration and/or LTSS-Medicaid.

Experience with claims systems, adjudication, submission processes, coding, and/or dispute resolution.

Advanced knowledge of provider network operations tools, processes, and best practices.

Proficiency in analyzing, understanding, and communicating complex issues, along with ability to facilitate meetings with diverse audiences.

Ability to manage and prioritize multiple projects in a fast-paced environment to achieve results.

Work at Home Requirements

At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.

Satellite, cellular and microwave connection can be used only if approved by leadership.

Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.

Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.

Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Preferred Qualifications

Some experience working with facilities and ancillary providers, and/or FQHCs.

Thorough understanding of managed healthcare contracts, including provider contract language and reimbursement.

Strategic thinker with ability to work independently.

Prior process creation or improvement experience.

Proficient in MS Office Applications including Microsoft Project, SharePoint, Teams, MS Word, PowerPoint, Outlook, and Excel.

Additional InformationWorkstyle: Remote, primarily Work at Home with occasional travel to Humana/provider offices in the state of Illinois.Location: This is a work at home position with occasional travel in the State of Illinois.Schedule: Typically, 8:00 AM to 5:00 PM Monday through Friday (Central Standard Time)Travel: Up to 20%, travel across the state of Illinois to Humana/provider offices.Interview FormatAs part of our hiring process, we will be using an exciting interviewing technology provided by Hire Vue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making.If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes.If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed, and you will subsequently be informed if you will be moving forward to next round of interviews.Scheduled Weekly Hours40Pay RangeThe compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$76,800 - $105,800 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.Description of BenefitsHumana, Inc. and its affiliated subsidiaries (collectively, 'Humana') offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.About usHumana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.Equal Opportunity EmployerIt is the policy of  Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or because he or she is a protected veteran. It is also the policy of  Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all 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 all levels of employment.Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our https://www.humana.com/legal/accessibility-resources?source=HumanaWebsite.