Provider Network Specialist (Provider Relations) - Rhode Island (Remote & Field Based) - Providence - job 636245

Wellcare

Date: 02/23/2021

City: Providence, Rhode Island

Employment type: 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.





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