Provider Network Specialist (Provider Relations) - Rhode Island (Remote & Field Based)
- Full-time
Company Description
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.
Job Description
Position Purpose:
Perform duties to act as a liaison between providers, the health plan and Corporate.
Perform training, orientation and coaching for performance improvement within the network and assist with claim resolution.
Serve as primary contact for providers and act as a liaison between the providers and the health plan
Conduct monthly face-to-face meetings with the provider account representatives documenting discussions, issues, attendees, action items, and research claims issues on-site, where possible, and route to the appropriate party for resolution
Receive and effectively respond to external provider related issues
Provide education on health plan’s innovative contracting strategies
Initiate data entry of provider-related demographic information changes and oversee testing and completion of change requests for the network
Investigate, resolve and communicate provider claim issues and changes
Educate providers regarding policies and procedures related to referrals and claims submission, web site usage, EDI solicitation and related topics
Perform provider orientations and ongoing provider education, including writing and updating orientation materials
Ability to travel
Qualifications
Education/Experience:
Bachelor’s degree in related field or equivalent experience. 0-2 years of provider relations or contracting experience. Knowledge of health care, managed care, Medicare or Medicaid. Bachelor’s degree in healthcare or a related field preferred. Claims billing/coding knowledge preferred.
Licenses/Certifications: Current state driver’s license.
For South Carolina only - Current state driver's license preferred.
Additional Information
All your information will be kept confidential according to EEO guidelines.