Provider Engagement Representative Position Available In Hillsborough, Florida

Provider Engagement Representative SECUR Tampa, FL Job Details Full-time $65,996.22 – $98,994.33 a year 22 hours ago Qualifications Bilingual Spanish Management Medicare Managed care Healthcare Administration English Mid-level Analysis skills Driver’s License Bachelor’s degree Network management Business Administration Public relations Business Communication skills Marketing Negotiation Full Job Description It’s inspiring to work with a company where people truly BELIEVE in what they’re doing! When you become part of the SECUR Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing groundbreaking solutions for our clients’ unique needs offering a wide variety of compassionate healthcare choices. Our employees make all the difference in our success!

Qualifications:

Bachelor’s degree in business administration, healthcare administration, public relations, marketing, or related field required Prior experience in healthcare administration, public relations or related field preferred Provider relations, network management, or contracting experience within a managed care health plan or managed care setting preferred; experience in value-based contracting and risk-sharing models is a plus Strong knowledge of Medicare, Medicaid, and commercial health plan regulations Excellent interpersonal, communication, organizational, presentation and collaboration skills Strong analytical and problem-solving skills to include understanding of when to escalate problematic situations Excellent negotiation and relationship-building skills Ability to function independently, attend to detail, work under changing priorities, and successfully juggle multiple projects to meet changing deadlines Ability to work well under high demands and manage sensitive or controversial subjects with tact, kindness, and professionalism Fully bilingual in English and Spanish- ability to speak, read and write in English and Spanish required Mobile Driver – Valid driver’s license and automobile insurance per Company policy Proficiency in provider database systems, claims analytics tools

Competencies:

Satisfactorily complete competency requirements for this position.

Key Responsibilities:

Coordinates Medicare Advantage Health Plan provider meetings to educate and review all aspects of the health plan, including Model of Care Training, claims processing, credentialing, eligibility, disease and utilization management and quality and risk adjustment programs; responsibilities include scheduling meetings, preparing agenda and materials, ordering food and beverages and documenting meeting minutes Educates health plan providers on Medicare Advantage Health Plan benefits, policies, procedures, and compliance requirements via in-person and virtual presentations Resolves provider concerns efficiently and effectively, including claims processing issues and payment discrepancies, by collaborating with internal departments Collaborates with predictive analytics team and the Medical Director to develop, execute, and monitor provider performance and patient outcomes Monitors provider performance metrics and escalates concerns as needed Stays current on Medicare regulatory affairs, innovative payment models, and value-based care initiatives Analyzes provider performance data, utilization trends, and quality metrics to drive improvements in care delivery and successful financial outcomes Collaborates with the contracting team to ensure provider data accuracy and update provider directories as needed Completes Practitioner Data Forms and Provider Change Forms in a timely manner Identifies at-risk situations and assists in developing escalation and corrective action plans Conducts site visits as required by the National Committee for Quality Assurance Ensures providers maintain compliance with all regulatory and contractual obligations for the health plan Performs other duties as assigned

Compensation Pay Range:

$65,996.22 – $98,994.33 This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy.