Job Title: Provider Relations Specialist I Job Type: Full-Time Location: Fort Lauderdale, FL
Job Description:
Position Purpose: Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider claims issues. Perform training, orientation and coaching for performance improvement within physician practices.
Knowledge/Experience: College degree in Marketing, Communications, Public Relations or Business or equivalent. Knowledge of health care, managed care, Medicare or Medicaid. 3-5 years experience in Sales or Public Relations preferred. Claims billing/coding knowledge preferred.
Licenses/Certifications: Current state driver's license.
Position Responsibilities: . Serve as primary contact for providers serving as a liaison between the provider and the health plan . Conduct monthly face to face meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on-site and routing to the appropriate party for resolution . Receive and respond to external provider related issues. . Initiate entry or change of provider related database information. . Recommend changes in pricing subsystems. . Author change requests and oversee through testing and completion. . Investigate and communicate provider changes. . Educate providers regarding policies and procedures related to referrals and claims submission; web site education, EDI solicitation and problem solving (liaison responsibilities) . Perform Provider orientations (includes writing/updating orientation material when necessary) . Must have a good driving record and the ability to travel.
