Provider Relations

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JOB DESCRIPTION

  • Liaison between health plan and the participating providers
  • Responds to provider needs and inquiries
  • Provider education for office staff to include plan and benefit information, plan administration, and web portal assistance
  • Create and distribute provider communication materials
  • Collaboration and communication with other departments on provider issues, projects, and process implementation
  • Participate in health plan audit preparation
  • Maintain confidentiality of all patient information, as per HIPAA guidelines
  • Maintain a full comprehensive understanding of the covered benefits, reimbursement policies, and contracts
  • Ensure integrity of departmental database by thorough, timely and accurate entry, consistent with regulatory protocols and applicable Policies and Procedures
  • Production and submission of reports as required
  • Other duties, as assigned

Primary Responsibilities:

  • Develops provider communication materials such as provider notices, education materials, and manuals
  • Statewide provider recruitment
  • Functions as a provider specialist providing education and in-services via telephone or in-person when needed
  • Ensures provider data accuracy
  • Very strong written and verbal skills are required
  • Establishes and maintains provider relationships
  • Handles provider complaints and grievances from health plan partners
  • Maintains and provides network adequacy reporting
  • Assists other departments/teams as necessary
  • Serves as a resource to others
  • Proven, strong relationship builder/maintainer with internal clients and external providers, and have operational knowledge of managed care or healthcare plans
  • Excellent interpersonal skills
  • Excellent organizational skills
  • Good analytical skills and the ability to problem solve creatively, objectively and rapidly
  • A positive, flexible and self-motivated attitude, with superior teamwork skills in a multi-disciplinary environment
  • Ability to work in a time sensitive environment
  • Computer literate and proficiency in Microsoft Office and data management systems
  • Strong understanding of health plan terminology required.

JOB REQUIREMENTS

Required Qualifications:

  • Bachelor’s degree
  • Ability to work independently
  • Proficient experience using Microsoft office – Outlook, Word, Excel, and Power Point
  • Some travel may be required
  • Excellent oral and writing skills.
  • Demonstrated ability to articulate goals, plan and implement processes, and meet deadlines.
  • Advanced interpersonal skills.

Preferred Qualifications: 

  • Experience with Optometry, Ophthalmology and or Podiatry specialties.
  • Bilingual (English and Spanish) preferred.

BENEFITS
At iCare Health Solutions we are a dedicated family of professionals with a strong desire to deliver quality services to our clients and their customers. We promote from within and offer internal advancement opportunities. For this role we offer a competitive pay rate and

benefits package. We provide the resources, training and support you need to be successful!

Our associates enjoy a fun and team oriented environment.

Other benefits of the CSR role include:

  • Paid Time off program
  • Paid Holidays

Voluntary Benefits

  • 401(k) Retirement Plan with Company Match
  • Healthcare Insurance
  • Medical and Dental Insurance
  • Short & Long Term Disability
  • Life Insurance

Location: Tampa, FL
Schedule: Monday – Friday, various shift times

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2017-10-18T18:49:17+00:00