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Corporate Functions & Operations WellCare - Clinical Support Careers

Hospital Services Specialist Job

Full Job Title: Hospital Services Specialist

Job Number: 1803965

Location: Miami, FL

Date Posted: 2018-08-29

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

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.

    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 previous experience working directly with customers
    • Required 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 ability to work with less structured, more complex issues
    • Advanced critical thinking skills
    • Intermediate presentation skills
    • Intermediate ability to support project/issue resolution

    Technical Skills:

    • Required intermediate Microsoft Word
    • Required intermediate Microsoft Excel
    • Required intermediate Microsoft Outlook


    • Bilingual helpful

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    Last Updated On: 12/9/2015