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Corporate Functions & Operations WellCare - Clinical Support Careers

Hospital Services Specialist Job

Full Job Title: Hospital Services Specialist - Kapolei

Job Number: 1703470

Location: Oahu, HI

Date Posted: 7-31-2017

Location: Kapolei
Reports to: Provider Relations Manager
Dept.: Provider Relations
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.

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, Excel, and Outlook


  • Bilingual helpful

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Last Updated On: 12/9/2015