Provider Operations Coordinator

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 Operations Coordinator to our Provider Services 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:

Supports the Provider Relations Field Representative to achieve department goals.  Answer incoming telephone inquiries from providers and assist with problem resolution of issues.  Perform Excel data analysis.  Process incoming mail.  Coordinate submission of provider contract records to internal departments.

 

Essential Functions: Complete monthly reports and track incoming/outgoing paperwork.Manage the out-of-network arrangement process and acts as a liaison with Utilization Management.Work with the assigned Provider Relations Representative to resolve provider concerns.Researches and resolve claims inquiries.Reviews and process incoming/outgoing paperwork, including provider contracts, changes and related forms.Answer phones for Provider Relations department.File paperwork.Provides office, project management, provider recruitment and data analysis support.

 

Additional Duties: Assist in projects work as necessary as required.Attends provider meetings.

 

Supervision Received/Exercised:General supervision by check on completed work.  Independent problem resolution.



Scope of Decisions: Position requires daily use of considerable discretion and judgment especially when dealing with incoming servicing issues across multiple counties and multiple product lines.

 

Knowledge, Skills, Abilities Required:

 

Education/Experience: Associates Degree preferred.  Minimum of 3 years experience in comparable Healthcare servicing position, such as customer service, sales, and/or provider relation.Minimum 1 year experience in government programs is preferred. 

Communication and Numeric Skills: Excellent problem solving skills.Excellent oral and written communication skills.Must be organized and have excellent time management capabilities.Ability to analyze data to identify trends, and variance from goals.

 

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

 

Physical Demands:Office support staff

 

Other:Occasional out of town travel may be required

 

Working Conditions:Climate controlled office during normal business hours.