Senior Provider Relations Advocate

Primary Responsibilities:

Job Scope and Guidelines
Generally work is self-directed and not prescribed
Works with less structured, more complex issues
Serves as a resource to others
Assesses and interprets customer needs and requirements
Identifies solutions to non-standard requests and problems
Solves moderately complex problems and/or conducts moderately complex analyses
Works with minimal guidance; seeks guidance on only the most complex tasks
Translates concepts into practice
Provides explanations and information to others on difficult issues
Coaches, provides feedback, and guides others
Acts as a resource for others with less experience 
In this role you will be expected to:
Apply basic knowledge of provider network functions, ability to work in a fast-paced environment
Intermediate skill level in Microsoft programs (Teams, Outlook, Word, Excel, PowerPoint) and spreadsheet management Microsoft Access knowledge is a plus
Ability to take initiative and use problem-solving skills for issue resolution
Depend minimally on others for instruction, guidance or direction Must be attentive to detail, work with flexibility, and have the capability of multi-tasking to meet deadlines and deliverables
Possess knowledge in Medicaid and Long Term Care (Home and Community Based) programs
Must have good communication skills; and the ability to build and retain relationships with Provider/Ancillary providers
Experience working with Health Plan contracts in compliance with company contract templates to ensure the network composition includes an appropriate distribution of provider specialties
Display professional work ethics in a structured work environment
Team environment aptitude, work in partnership with Sr Provider Relations Advocates and interact well with staff in cross-segment departments
Perform other duties as required

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

5+ years working in a network management-related role, such as contracting or provider services
3+ years of experience in ancillary/facility/group credentialing, to include knowledge of credentialing requirements for the State of Florida
3+ years working with provider/group Medicaid/Long Term Care contracts, claims, credentialing
3+ years of experience in performing network adequacy analysis
Intermediate level of knowledge of Medicaid and Long Term Care reimbursement methodologies
Intermediate level in Microsoft Word, Excel, PowerPoint, Access
Proven ability to work in a fast-pace ever-changing environment
Proven excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information form others
Proven solid interpersonal skills, establishing rapport and working well with others
Proven solid customer service skills
Driver’s License and access to a reliable transportation