Provider Relations Representative
On-siteHollywood, Florida, United States
Job Summary
Conduct provider orientations for newly contracted providers and secure signed acknowledgements within specified timeframes. Maintain original copies of educational forms and disseminate the Provider Handbook, bulletins, and policies to the network. Perform annual and periodic site visits for Primary Care Physicians and high-volume specialists, completing required tools and monitoring after-hours survey accessibility. Coordinate benefit presentation dinners and actively participate in Quality Management initiatives, corrective action plans, and claim dispute settlements. Resolve provider complaints and disputes while ensuring all communication materials remain current. Maintain proficiency in federal and state regulatory matters governing Medicare Advantage operations.
Required Qualifications
- 3 - 5 years' experience with a Medicare Advantage Health Plan
- BS/BA Degree
- Commitment to the Health Plan's vision and mission
- Excellent communication skills, both in oral and written
- Demonstrable knowledge of provider reimbursement methodologies applicable to Medicare Advantage Health Plans and other federal health insurance programs
- Knowledge of CMS, AHCA and other federal and state current regulatory governing guidelines applicable to HMOs
- Excellent organizational skills
- Flexible Disposition to enable management of special projects
- Excellent Customer Service Skills to enable resolution of complex and varied situations involving multiple internal and external stake holders
- Ability to drive key organizational / operational initiatives
Desired Qualifications
- Fully Bilingual English / Spanish (preferred)
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