Plan and Provider Specialist- Tallahassee, FL (Hybrid)

Gainwell Technologies LLC•Tallahassee, FL

4d•$42,100 - $60,100•Hybrid

About The Position

As a Plan and Provider Specialist - Tallahassee, FL - Hybrid at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. A Bilingual Plan and Provider Specialist provides quality training and education to the Florida Medicaid provider and health plan communities both virtually and onsite, as required. Knowledgeable in claims processing and adjudication, Medicaid policy, enrollment processes, and health plan policies and procedures. Receives incoming inquiries from a variety of sources, including email, call center escalations, the Agency, and the public Web Portal. Responds quickly and professionally to Agency, provider, and health plan inquiries with resolutions to problems/issues that may require extensive research. Coordinates with other departments regarding identified system issues and follows through to resolution; this may include, but is not limited to enrollment, claims, and EDI issues. Meets regularly with leadership to review status of escalations/inquiries to ensure timely responses. Performs other duties as assigned. Under minimal direction, performs routine and complex tasks related to the support of Florida Medicaid providers. Applies knowledge of established procedures to research and resolve escalated customer questions or management requests. Acts as the initial contact for escalated issues from the support staff and escalates only the most complex issues to the immediate supervisor. Researches and analyzes claim processing outcomes, identifies issues and reports as necessary, and proactively outreaches to peers, Supervisor, and/or providers upon findings. Refers questionable claim issues to the appropriate department. Provide support to Plan and Provider Specialist peers. Facilitates Health Plan Support meetings and supports Call Center staff. Be involved in other provider-related outreach, as needed. Prepares and analyzes administrative reports; makes recommendations to management. Examples of work performed may include claims research; new employee training; mentoring other Plan and Provider Specialists by assisting with training and building Client and provider relationships. Performs other support activities and duties as assigned.

Requirements

Knowledgeable in claims processing and adjudication, Medicaid policy, enrollment processes, and health plan policies and procedures.
Great organizational skills and time management habits
Strong detail-oriented skills with an ability to multi-task
Excellent verbal and written communication skills (examples include, ability to write clear and concise billing instructions to providers, interpret effects of change orders on systematic claim processing)
Professional when communicating with clients, management, and peers.

Nice To Haves

Ability to speak English and Spanish fluently is a plus

Responsibilities

Provides quality training and education to the Florida Medicaid provider and health plan communities both virtually and onsite, as required.
Responds quickly and professionally to Agency, provider, and health plan inquiries with resolutions to problems/issues that may require extensive research.
Coordinates with other departments regarding identified system issues and follows through to resolution; this may include, but is not limited to enrollment, claims, and EDI issues.
Meets regularly with leadership to review status of escalations/inquiries to ensure timely responses.
Performs other duties as assigned.
Performs routine and complex tasks related to the support of Florida Medicaid providers.
Applies knowledge of established procedures to research and resolve escalated customer questions or management requests.
Acts as the initial contact for escalated issues from the support staff and escalates only the most complex issues to the immediate supervisor.
Researches and analyzes claim processing outcomes, identifies issues and reports as necessary, and proactively outreaches to peers, Supervisor, and/or providers upon findings.
Refers questionable claim issues to the appropriate department.
Provide support to Plan and Provider Specialist peers.
Facilitates Health Plan Support meetings and supports Call Center staff.
Be involved in other provider-related outreach, as needed.
Prepares and analyzes administrative reports; makes recommendations to management.
Performs other support activities and duties as assigned.