Provider Relations Specialist II
Posted on: 18 Oct 2021
Iowa City, Iowa
Job Description
Position Purpose:
Serve as a liaison between providers, the health plan and Corporate to investigate and resolve provider claims
Conduct on-site provider orientations, including writing and updating orientation materials and assisting providers acclimated to plan website
Monitor financial performance of contracts
Investigate and document provider changes and correspondence
Coordinate with credentialing to ensure all appropriate documentation is received
Serve as a lead for key special projects
Recommend changes in pricing subsystems
Coordinate printing of provider directories with corporate and plan level entities
Investigate and respond to complex provider related issues and initiate change of provider related database information
Serve as a subject matter expert for provider relations activities and as a mentor for Provider Relations Specialist I staff
Ability to travel
Our Comprehensive Benefits Package:
Flexible work solutions including remote options, hybrid work schedules and dress flexibility
Competitive pay
Paid Time Off including paid holidays
Health insurance coverage for you and dependents
401(k) and stock purchase plans
Tuition reimbursement and best-in-class training and development
Education/Experience:
High school diploma or equivalent. Bachelor’s degree in healthcare related field preferred. 5+ years of sales, provider relations, or contracting experience. Claims processing and/or managed care experience preferred. Driver’s License may be required by some plans. Specific language skills may be required by some plans.
WellCare
Tampa, FL
WellCare Health Plans, Inc. provides government-sponsored managed care services. The company operates in three segments: Medicaid Health Plans, Medicare Health Plans, and Medicare Prescription Drug Plans (PDPs). The Medicaid Health Plans segment offers plans for beneficiaries of temporary assistance for needy families, supplemental security income, and aged blind and disabled residents; and other state-based programs, such as children's health insurance programs and long-term services and supports programs for qualifying families who are not eligible for Medicaid.
The Medicare Health Plans segment provides Medicare, a federal program that provides eligible persons aged 65 and over, as well as some disabled persons with a range of hospital, medical, and prescription drug benefits; Medicare Advantage, a Medicare’s managed care alternative to the original Medicare program, which offers individuals standard Medicare benefits directly through Centers for Medicare & Medicaid Services; and coordinated care plans that are administered through health maintenance organizations and require members to seek health care services and select a primary care physician from a network of health care providers.
The Medicare PDPs segment provides Medicare part D PDP plans to Medicare-eligible beneficiaries. Its PDP plans offer national in-network prescription drug coverage, including a preferred pharmacy network. As of December 31, 2018, the company served approximately 5.5 million members in the United States. WellCare Health Plans, Inc. was founded in 1985 and is headquartered in Tampa, Florida.
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IndustryHealthcare
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No. of Employees12, 000
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Website
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Jobs Posted917
