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Field Provider Svc Spec, Sr Job Details

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Company:  WellCare Health Plans, Inc.
Job Code:  1102664
Categories:  For-Profit Senior Services
Job Role:  Insurance
Region/Province:  Florida (FL)
City:  FL-Tampa
Job Description:  !*!About WellCare: WellCare Health Plans, Inc. (NYSE: WCG) provides managed care services exclusively for government-sponsored health care programs, focusing on Medicare and Medicaid. Our experience and our exclusive commitment to these programs enable us to serve our members and providers as well as manage our operations effectively and efficiently.

A 2008 Fortune 500 company headquartered in Tampa, Florida, WellCare offers a variety of health plans for families, children and the aged, blind and disabled, as well as prescription drug plans. The company employs approximately 3,500 associates and serves nearly 2.4 million members nationwide as of March 31, 2011. For more information about WellCare, please visit the Company's website at www.wellcare.com.
 

Researches, resolves and manages claims projects for the Medicare and Medicaid lines of business regarding reimbursement issues, health plan payment methods, benefit coordination and eligibility/enrollment operations.

 

Essential Functions:


  • Resolves complex provider issues.  Ensures timely response to escalated provider issues and resolution with root cause mindset.

  • Develops and implements continuous improvement processes to reduce the occurrence of inaccurate claim payments.

  • Maintains effective provider relations through meetings and education sessions regarding accurate coding and billing of claims.

  • Ensures that services comply with governmental and accrediting agency regulations.

  • Ensures the delivery of superior customer services by providing timely and accurate resolution to claims related provider inquiries and complaints regarding claims processing.

  • Plans and conducts own work on complex projects/programs necessitating the origination and application of new and unique approaches.

  • Recommends and implements changes to streamline departmental operations.

  • Supports Divisional operations initiatives as assigned.  

  • Perform other duties as assigned.

 

Education:  A Bachelor's Degree preferably in a Health Administration, Business or related field required.    

 

Experience:  4 years of previous Managed Care industry experience with a focus on complex claims operations and best practice.  In-depth knowledge of Medicare/Medicaid process, rules, regulations and procedures. Previous experience working directly with customers.

 

Licenses/Certifications:  Coding certification preferred but not required.

 

Special Skills (e.g. 2nd language): 

Excellent communication, interpersonal skills and decision-making skills

Ability to work successfully in a team environment

Excellent analytical and problem solving skills

Excellent written communication

Solid presentation skills

Must be able to have a business presence in face of adversity with customers

Ability to work independently and support project / issue resolution

Ability to perform a multitude of tasks simultaneously in a fast-paced customer-centered organization
Post Date:  02/16/2012

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