Job Description:
LTSS Network Relation
s Consultant
Travel - this position will require you to travel 3 - 4 days per week in the following territories: Kissimmee, Orlando, Winter Haven, Sanford and Titusville Region 7
How you will make an impact:
- Develops and maintains positive provider relationships with provider community by regular on-site visits, communicating administrative and programmatic changes, and facilitating, education and the resolution of provider issues.
- Serving as a knowledge and resource expert regarding provider issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution.
- May be responsible for coordinating non-negotiated contracts for new and existing providers as needed.
- Researches, analyzes and recommends resolution for contract dispute, non-routine claim issues, billing questions and other practices.
- May participation in Joint Operation Committees (JOC) of larger provider groups.
- Coordinates communication process on such issues as administrative and medical policy, reimbursement and provider utilization patterns.
- Conducts seminars to support the understanding of managed care policies and procedures.
- Identifies network access and deficiencies and develops recruitment and contracting strategies.
- Coordinates and conducts provider training including developing and distributing provider relations materials.
- Responsible for providing quality, accessible and comprehensive service to the company's provider community.
- Provide assistance regarding education, contract questions and non-routine claim issues.
- Coordinates communications process on such issues as administrative and medical policy, reimbursement, and provider utilization patterns.
- Coordinates prompt claims resolution through direct contact with providers, claims, pricing and medical management department.
- Identifies and reports on provider utilization patterns which have a direct impact on the quality-of-service delivery.
- Tracks and conduct provider refresher training.
- Research issues that may impact future provider negotiations or jeopardize network retention.
Minimum Requirements:
- Requires a bachelor's degree and a minimum of 3 years of customer service experience including 2 years' experience as a Network Management Rep; or any combination of education and experience, which would provide an equivalent background.
- Travels to worksite and other locations, as necessary.
Preferred Skills, Capabilities, and Experiences:
- Long term care experience
- Assisted living facilities
- Experience working with Medicaid providers
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