New job Provider Field Services Representative (Tampa Area) in Florida

Investigates claim submissions to assist with claim billing and denials . Responds to provider inquiries and assists providers to resolve problems/issues. Provides directions for utilization review. Approves any remedial or recoupment actions associated with escalated claims. Advises provider review councils, state officials and works with organized healthcare groups and associations on various medical issues related to insurance and healthcare programs.

Responsibilities:

• Participates in the identification, documentation, analysis and validation of basic business processes, systems, and solution requirements.

• Review data and make independent decisions with some direction.

• Weekly travel to provider sites

• Training providers

• Coordinates and leads meetings with various health plan organizations

• Learns policies and procedures as they relate to the contract.

• Researches components of solutions to problems.

• Handles escalated issues from the providers and/or client.

• Supports requirements of business unit.

• Learn internal processes tools.

• Works effectively in a team environment.

• Establishes customer satisfaction by responding to requests for data-service in a timely and quality manner.

• Ability to take direction and follow general instructions.

• Manage assignments with limited supervision.

• Manage requests from customers and leaders.

Education and Experience Required:

• Bachelor's degree in insurance, healthcare or related field

• Typically, 1-3 years of working experience in a related field.

• Medicaid or health insurance experience preferred

• Training/teaching onsite or remotely (webinar or similar tools)

• Candidate must be located near Tampa area.

Knowledge and Skills:

• General healthcare knowledge of commercial and government insurance programs.

• Basic understanding of healthcare related technologies.

• Basic knowledge of project management, research and problem resolution techniques.

• Ability to plan and meet deadlines.

• Ability to communicate effectively with both internal and external customers.

• Good written and verbal communication skills.

• Ability to understand instructions and accomplish tasks.

• Ability to work in a team environment.

• Good business and technical writing skills to ensure that all documentation meets required standards.

• Advanced computer skills to minimize training time for organization specific software.

• Excellent research skills.