This link will leave wellcare.com, opening in a new window. WellCare and its subsidiaries are not responsible for non-WellCare content, privacy practices, products or services described on these websites.
Position provides direct management of exempt and non-exempt associates responsible for accurate and timely maintenance of provider network, related automated pricing methodologies, daily workflow of team, and configuration liaison between the Market and Shared Services.
Oversees systematic processing of provider files sent from external vendors as well as those created internally through Batch processes.
Maintains technical understanding of price rules, fee schedules, and provider contract loads, assures staff is trained and up to date on these.
Manages and monitors key performance metrics and implements improvement plans either with an individual or at an aggregate level.
Handles all direct employee personnel issues and processes (where applicable), including performance management, appraisal processes, development planning, and career pathing.
Performs root cause analysis on global issues that affect downstream processes, including automated claims payments and Provider Directories.
Supervises direct reports by assigning workload, monitoring quality and associate coaching.
Serves as liaison between departments when it becomes necessary due to member or workflow issues.
Develops, recommends, and implements process improvements to improve efficiencies and services provided.
Oversees training associates on new processes and refresher training.
Facilitate and participate in meetings with other departments and line of business as needed.
Act in a liaison capacity for the Mgr/ Sr Mgr representing operations with other areas and business units.
Demonstrates desired behaviors by exceeding others expectations and leads by example
Completes gap analysis on training for the business.
Other duties as assigned.
Additional Responsibilities:Candidate Education:
Required A High School or GED
Preferred A Bachelor's Degree in a related field
Required 4 years of experience in Provider Network Development, Fee Schedules, High Volume Automated Claims Processes
Required Other Experience leading others on complex automated projects
Intermediate Demonstrated analytical skills
Intermediate Demonstrated written communication skills
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Ability to communicate and make recommendations to upper management
Intermediate Other Technical understanding of automated claims processing, fee schedules, provider network structures, provider reimbursement methodologies. Understanding of contract terms and how they are loaded into the system.
Intermediate Other In-Depth knowledge of Health Insurance
Intermediate Other Strong understanding of managed care and its place in the health care industry
Licenses and Certifications: A license in one of the following is required: Technical Skills:
Required Intermediate Microsoft Word
Required Intermediate Microsoft Outlook
Required Intermediate Microsoft Excel
Required Intermediate Other Proficiency with all WellCare based systems utilized in job functions.