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Corporate Functions & Operations WellCare - Clinical Support Careers

Hospital Services Specialist Job

Full Job Title: Hospital Services Specialist

Job Number: 1803146

Location: New York, NY

Date Posted: 5-25-2018

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
Report to: Senior Director, 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.
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


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Last Updated On: 12/9/2015