Hospital Services Specialist

Manages the relationship and all levels of operations support with network hospitals. Provides ongoing education to facilities regarding health plan operations. Identifies and implements process improvements and enhancements.
DEPARTMENT: Provider Relations
REPORTS TO: Manager, Provider Relations
Location: Miami, Florida

Essential Functions:
  • Establishes and maintains strong business relationships with hospitals in assigned area.
  • Responds in a timely fashion to identified concerns.
  • Plans and facilitates hospital meetings as needed.
  • Designs and implements programs to build and nurture positive relationships between the health plan, providers (hospitals/facilities) and hospital administrators.
  • Performs provider education through in-service activities and regularly scheduled follow up with providers.
  • Effectively influences outcomes of key internal and external business issues.
  • Identifies internal and external operational short-falls and researches and remediates claims.
  • Executes internal business initiatives (e.g. EDI, EFT/ERA).
  • Researches, collects and analyzes data on hospitals and other assigned projects.
  • Designs reports to serve as a basis for decision making on hospital related issues.
  • Supports effective interdepartmental communication.
  • Performs other duties as assigned.
Additional Responsibilities:

    Candidate Education:

    • Required A Bachelor's Degree in Health Administration, Business or related field

    Candidate Experience:

    • Required 2 years of experience in the managed Care industry with a focus on claims operations and best practices
    • Required Other Previous experience working directly with customers
    • Required Other In-depth knowledge of Medicare/Medicaid process, rules, regulations and procedures.

    Candidate Skills:

    • Advanced Demonstrated interpersonal/verbal communication skills
    • Advanced Demonstrated written communication skills
    • Advanced Demonstrated analytical skills
    • Advanced Demonstrated problem solving skills
    • Intermediate Ability to work as part of a team
    • Intermediate Ability to work independently
    • Advanced Ability to represent the company with external constituents Customer relations business acumen
    • Intermediate Ability to multi-task Ability to perform a multitude of tasks simultaneously in a fast-paced customer-centered organization
    • Intermediate Other Ability to work with less structured, more complex issues
    • Advanced Other Critical thinking skills
    • Intermediate Other Presentation skills
    • Intermediate Other Ability to support project/issue resolution

    Licenses and Certifications:

      Technical Skills:

      • Required Intermediate Microsoft Word Proficient in Microsoft Office such as Word, Excel, and Outlook
      • Required Intermediate Microsoft Excel
      • Required Intermediate Microsoft Outlook

      Languages:

        About us
        Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans to families, children, seniors and individuals with complex medical needs. WellCare is a Fortune 500 company, and in 2018, was recognized as a Fortune "World's Most Admired Company", ranking in the top five among the health insurance and managed care industry-a testament to the hard work and dedication of the company's nearly 9,000 associates who each day live WellCare's values and deliver on its mission to help its members live better, healthier lives. The company serves approximately 4.4 million members nationwide as of Dec. 31, 2017. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.