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Provider Relations Specialist

Location: 6630 Orion Drive, Fort Myers, FL
Department: Administration - VBSO
Categories: Professional
Type: Full-Time
Shift: 8:00 AM-4:30 PM
Schedule: Days

Description:

Responsible for helping assist in the management of network providers in collaboration with senior leadership and clinical leadership teams. Functions as a Provider Relations Specialist for assigned providers within the Vivida Network. Develops collaborative and positive working relationships with provider practice staff. Meets with or communicates with assigned practices in collaboration with clinical teams to review pertinent performance data. Provides additional education and/or tools in addition to the clinical teams for corrective actions in line with approved regulatory guidelines and company policies. Introduce and familiarize providers on all aspects of the provider manual related to services, benefits and provider requirements; care coordination and authorization protocols; claims filing; and the web portal. Helps ensures provider network meets the health care needs of Vivida plan members though multidisciplinary collaboration and investigation to identify any gaps in the network and access to care issues.

Requirements:

Educational Requirements

Degree/Diploma ObtainedProgram of StudyRequired/
Preferred
and/or
Bachelor'sRequired
Master'sHealthcare AdministrationPreferred

Experience Requirements

Minimum Years RequiredArea of ExperienceRequired/
Preferred
and/or
3 YearsHealthcareRequired

Additional Requirements

• Minimum of 3 years’ relevant experience with an in-depth knowledge of managed care preferred specifically Medicaid

Minimum of 3 years’ experience in provider relations experience or comparable experience preferred.

Operational knowledge and experience with Office including Excel, Microsoft and Visio

NCQA Accreditation experience.


State of Florida Licensure Requirements

LicensesRequired/
Preferred
and/or
Not Required

Certifications/Registration Requirements

Certificates/RegistrationsRequired/
Preferred
and/or

Other Requirements

Must be self-motivated

Good communication (written and oral), interpersonal, problem resolution and critical thinking skills

Excellent human relations skills

Be able to work effectively in a team setting

Ability to follow a project or assignment through a successful completion.