MiamiRecruiter Since 2001
the smart solution for Miami jobs

Provider Relations Representative

Company: Florida Community Care
Location: Fort Lauderdale
Posted on: July 16, 2019

Job Description:

POSITION SUMMARY Essential duties and responsibilities include the following: The Provider Relations Specialist is responsible for developing, maintaining and servicing high quality, marketable and satisfied provider network within an assigned geographic area. This position is expected to build and sustain strong working relationships with cross functional departments, and assigned Providers. The Provider Relations Specialist helps assigned Providers operate successfully within our healthcare delivery model by providing strategic education on the special needs of the enrollees, comprehensive understanding of the contract and the PSN plans quality initiatives. Key responsibilities include the following: Primary Responsibilities: Educating the providers to ensure they understand the contract and the Medicaid initiatives regarding this population and the contract requirements of the PSN. Educating the providers to the mandated best practices for their provider type and the quality measures of the PSN. Coordinates with other PSN internal departments to resolve questions or issues regarding prior authorizations, claims submission or payment issues. Conducts new provider orientations and ongoing education to providers and their staffs regarding claims, payments, eligibility, utilization management or any other questions impacting provider performance. Conducts provider meetings to share and discuss issues of concern, troubleshoots for issue resolution, and implements an escalation process for discrepancies. Handles or ensures appropriate scheduling, agenda, materials, location, of provider meetings as needed. Collaborates with Credentialing Department to ensure provider data is correct and include any needed updates. Assists providers to obtain and complete Provider Change Forms as needed. Provides information and participate in management meetings as requested. Regularly meets with other Provider Specialists to create, revise and adjust strategy for assigned Provider Groups to meet overall performance goals. Job Requirement To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Verbal Communication -Excellent verbal communication skills with the ability to clearly present information orally and/or influence others through oral presentation. Written Communication - Excellent written communication skills with the ability to effectively write and extract information from written material. Team Work - Ability to work with people and effectively motivate others to achieve intended goals and objectives. Organization and Planning- Ability to prioritize, organize tasks and develop the necessary action plans to accomplish specific goals, within the required timeframes/deadlines. Leadership - Ability to influence the actions and opinions of others in a desired action; to exhibit good sound judgment in leading others to profitable and rewarding objectives. Decision Making and Problem Solving: - Ability to identify a problem and implement interventions and solutions while exhibiting good sound judgment in the process; ability to take a systematic approach to decision making by identifying a problem or deficiency, examining the cause or barriers, and implementing interventions and improvement strategies. Travel - Ability to travel within Florida and outside of Florida, as necessary to visit providers, attend meetings and trainings. EDUCATION and/or EXPERIENCE: BA or BS degree or a minimum of five years' experience as a Provider Relation Specialist with a Health Plan. Bi- lingual Spanish English PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Independent Living Systems, LLC. is committed to protecting the safety, health and well-being of all employees and individuals in our workplace. We believe that alcohol abuse and illegal drug use are detrimental to achieving success as an individual and as a professional. Employment at Independent Living Systems, LLC. is contingent upon successfully passing a pre-employment drug test prior to start date. We are proudly a drug and alcohol-free workplace and will maintain to enforce such policy. Our drug and alcohol-free workplace policy is intended to apply whenever anyone is representing or conducting business for Independent Living Systems, LLC. Independent Living Systems, LLC is a Drug Free Workplace employer with an existing drug free workplace policy. Independent Living Systems, LLC provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, marital status, amnesty, or status as a covered veteran in accordance with applicable federal, state and local laws. Independent Living System, LLC complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities

Keywords: Florida Community Care, Miami , Provider Relations Representative, Other , Fort Lauderdale, Florida

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Other Jobs


Avon Glam Gig- Work from Home with Flexible Hours- Start today only $30 and choose FREE Gift Set
Description: Work from Home - Avon Sales Representative br About the Job br Work when you want and where you want. - make your own schedule. br Whatever your background, whether you come from Customer Service, (more...)
Company: Avon
Location: Boynton Beach
Posted on: 07/17/2019

Inbound Customer Care Rep
Description: We are looking for energetic, friendly, articulate, self-directed customer care advocates. You will answer customer's product questions, promote
Company: Mommy Jobs Online
Location: Boca Raton
Posted on: 07/17/2019

Run your own part-time business /AVON Glam Gig - Sign up today only $30 and choose a FREE Gift Set
Description: Work from Home - Avon Sales Representative br About the Job br Work when you want and where you want. - make your own schedule. br Whatever your background, whether you come from Customer Service, (more...)
Company: Avon
Location: Boynton Beach
Posted on: 07/17/2019


Email Marketing Specialist
Description: At Mommy Jobs Online our qualified recruiters will enjoy the freedom and profitability of independent recruiting 1099 while benefiting from the tools, branding and support of a national recruiting work (more...)
Company: Mommy Jobs Online
Location: Boynton Beach
Posted on: 07/17/2019

Email Marketing Specialist
Description: At Mommy Jobs Online our qualified recruiters will enjoy the freedom and profitability of independent recruiting 1099 while benefiting from the tools, branding and support of a national recruiting work (more...)
Company: Mommy Jobs Online
Location: Miramar
Posted on: 07/17/2019

$16-$35+/Hour UPS Jobs Hiring: (Positions Open)
Description: Easy Apply, Immediate
Company: UPS.FindDreamJobs.com
Location: Islamorada
Posted on: 07/17/2019

Bid On Local Window Installing Jobs - Reach New Customers In Your Area
Description: Over 25 million homeowners have trusted HomeAdvisor 1800Contractor to help them find quality professionals with the expertise to turn their home improvement
Company: HomeAdvisor
Location: Homestead
Posted on: 07/17/2019

Chiropractor
Description: Full time Chiropractor DC Needed in Boynton Beach Florida We are currently seeking Chiropractor DC to join a growing practice
Company: Healthcare Recruitment Counselors
Location: Boynton Beach
Posted on: 07/17/2019

Business Development Specialist
Description: Business Development and Marketing Automation SpecialistPosition Overview:--Estimating Edge is looking for a Business Development and Marketing Automation Specialist to build awareness and drive sales (more...)
Company: Estimating Edge
Location: Boynton Beach
Posted on: 07/17/2019

Contact Center Rep I, Boynton Beach Florida
Description: NYU Langone Health is a world-class, patient-centered, integrated academic medical center, known for its excellence in clinical care, research, and education. It comprises more than 200 locations throughout (more...)
Company: NYU Langone Health
Location: Boynton Beach
Posted on: 07/17/2019

Log In or Create An Account

Get the latest Florida jobs by following @recnetFL on Twitter!

Miami RSS job feeds