Provider Relations Representative - Rochester

 

WellCare Health Plans, Inc. (NYSE:WCG) a Fortune 1000 company, is the nation?s leading provider of government health insurance products dedicated to government-sponsored health plans such as Medicare, Medicaid, State Children?s Health Insurance Programs, Medicare Prescription Drug Plans and others. Founded in 1985, our team of 2,500 associates and over 20,000 physician partners serve 1.4 million members across the U. S. Our company headquarters are based in Tampa, FL. For more information about WellCare, please visit the Company?s website at www.wellcare.com.

 

We are looking to add a Provider Relations Representative to our Provider Relations team.  If you truly believe in teamwork, consistently demonstrate a high level of integrity and want to be a part of a dynamic, growing organization, then this may be the opportunity for you

Job Summary:

 

Manage physician network by developing and maintaining a specific geographic area.  Provides service and education to network physicians/providers.  Meet company targets through aggressive contract negotiations with primary care, specialty and ancillary providers in assigned county/counties.



 

Essential Functions:

 

Contract and negotiate with primary care and specialty physicians and ancillary providers for Medicaid, Medicare and Healthy Kids product lines.  Conduct new office orientations and continuous face-to-face service/educational meetings to ensure provider and staff understand company policies and procedures. Manage incoming provider inquiries: identify potential claims trends and follow-up with provider and internal departments to ensure that identified problems have been resolved. Manage the physician/provider re-credentialing process including (as needed) Site Survey visits. Work closely with the In-house Provider Relations staff regarding educational needs, claims issues and contracting questions.Assist in the analysis of claim trend data and/or market information to derive conclusions to support contract negotiations. 

Additional Duties:

 Identify network gaps and complete contracts. Routinely review out-of-network negotiations, identify providers for contracting, and complete contracting

 

Supervision Received/Exercised:

 General supervision on completed work and monitoring against established goals.

 

Scope of Decisions:

 Requires daily use of considerable discretion, judgment and independent problem solving.

 

Knowledge, Skills, Abilities Required:

 

Education/Experience: Bachelor?s degree is preferred Minimum of 3 years experience in Provider Relations Minimum of 1 year experience in government programs is preferred

 

Communication and Numeric Skills: Excellent influencing and negotiating skills. Ability to explain complicated financial terms and utilization data to physicians and staff. Excellent written skills and the ability to speak publicly are essential. Must be organized and have excellent time management capabilities. Ability to analyze data in Excel to identify trends, and variance from goals.

 

Computer Skills:Advance Word and Excel knowledge Ability to learn internal systems, Diamond and Sidewinder

 



Extensive out-of-office travel is required

Professional Appearance

 

Working Conditions:Travel to physicians office required, dependable car.  Regular out of office visits required.  May spend up to 70% of time traveling with exposure to inclement weather and normal road hazards.