Provider Relations Representative jobs in Miami, FL

ABOUT US

Join us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources.

Position Summary

The Provider Relations Representative is responsible for developing, maintaining and servicing high quality, marketable and satisfied provider network within an assigned geographic area. This position is expected to build and sustain strong working relationships with cross functional departments and Providers in the assigned geographic area. The Provider Relations Specialist helps Providers in the assigned geographic area operate successfully within our healthcare delivery model by providing strategic education on the special needs of the enrollees, comprehensive understanding of ILS contracts and the PSN plans quality initiatives. 

Essential Functions 

1. Educating the providers to ensure they understand the contract and the Medicaid initiatives regarding this population and the contract requirements of the PSN.
2. Educating the providers to the mandated best practices for their provider type and the quality measures of the PSN.
3. Coordinates with other PSN internal departments to resolve questions or issues regarding prior authorizations, claims submission or payment issues.    Conducts new provider orientations and ongoing education to providers and their staffs regarding claims, payments, eligibility, utilization management or any other questions impacting provider performance.
4. Conducts provider meetings to share and discuss issues of concern, troubleshoots for issue resolution, and implements an escalation process for discrepancies.
5. Handles or ensures appropriate scheduling, agenda, materials, location, of provider meetings as needed. 
6. Collaborates with Credentialing Department to ensure provider data is correct and include any needed updates.
7.  Assists providers to obtain and complete Provider Change Forms as needed.
8.  Provides information and participates in management meetings as requested.
9.  Regularly meets with other Provider Specialists to create, revise and adjust strategy for assigned Provider Groups to meet overall performance goals.

Education and Experience

• BA or BS degree or a minimum of five years’ experience as a Provider Relation Specialist with a Health Plan
• Bilingual in Spanish and English                                                                                                              

Required Skills

•   Ethical Conduct. 
•   Strategic-Critical Thinking. 
•   Leadership.
•   Decision Making. 
•   Financial Management. 
•   Communications Proficiency
•   Presentations Skills                                                                                                                                                                                          

EEO STATEMENT 

In compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.