Serves as an account lead with assigned providers maximizing the providers' ability to interact with WellCare. Manages education and issues related to claims, reimbursement, authorizations and referrals. Responsilble for onsite interaction as necessary with high maintenance providers/strategic providers only.
Additional Responsibilities:Candidate Education:
- Educates providers on common billing practice errors and reimbursement policies.
- Educates and drives adoption of self service tools (EDI, Provider Portal, EMR, etc.).
- Conducts root cause analysis on claims adjudication or related issues via direct access to applicable tools (eg; Omniflow).
- Service Model Support:
- Educate providers on service model to drive adoption and be the conduit to assist when service fails.
- Drives providers to the standard process but supplements and supports as necessary.
- Partners internally with information exchange when WellCare has failed on service.
- Conduit for provider issues that cross multiple platforms and/or result from integrations.
- Obtains signed documentation via face to face provider visit when necessary in support of recontracting lead by Network Development and recredentialing lead by Credentialling Dept. Scans and submits collected information in timely manner.
- Preferred A Bachelor's Degree in Health Administration, Business
- Required or equivalent work experience
- Required 3 years of experience in Previous experience in a professional level audit and recovery operations position with extensive experience working with claims data and inaccurate payments facing out to the provider may be considered.
- Preferred 1 year of experience in Physician/Hospital Billing Manager or Medical Practice Administrator strongly preferred.
Licenses and Certifications:
- Intermediate Other Basic knowledge of CPT and ICD-9/10 coding.
- Intermediate Other Strong relationship building skills and highly developed customer focus skills.
- Advanced Other Comprehensive knowledge of how a claim is built and paid.
- Advanced Other Understanding of practice management operations.
- Advanced Other Strong analytics or root-cause analysis experience.
- Advanced Other Highly developed presentation skills.
- Advanced Other Strong self-management skills, ability to handle rapid change and an affinity for continuous learning.
- Advanced Other Detailed knowledge about health plan operations.
A license in one of the following is required:
- Preferred Other CMPE (Certification of Medical Practice Executive)
- Required Advanced Microsoft Word
- Required Advanced Microsoft PowerPoint
- Required Advanced Microsoft Excel