Reports to: Dir, Provider Relations, NC Department: NC-Community Advocacy-State Position Location: Raleigh, NC
Supports the Provider Relations Field Representative to achieve department goals. Responds to customer service and provider relations inquiries from providers and assist with problem resolution of issues. Coordinates provider submissions to internal departments via required forms.
Works directly with internal and external partners to collect all required information to ensure correct processing of contracts, amendments and update requests.
Works with delegated providers and IPAs to process new provider load requests along with any updates or changes within the group via a roster methodology.
Supports the Provider Relations Representatives in resolving claims and payment issues.
Performs root cause analysis of delays in provider loading and assists in bringing to resolution.
Audits configuration loads on new contracts.
Provides office, project management, provider recruitment and data analysis support.
Performs special projects as assigned or directed.
May support provider enrollment and credentialing activities.
Required A High School or GED
Preferred An Associate's Degree in a related field
Required 1 year of experience in customer service or claims with exposure to problem resolution
Preferred 1 year of experience in physician credentialing
Intermediate Demonstrated problem solving skills
Intermediate Demonstrated interpersonal/verbal communication skills
Intermediate Demonstrated written communication skills
Intermediate Demonstrated organizational skills
Intermediate Demonstrated time management and priority setting skills
Intermediate Demonstrated analytical skills
Licenses and Certifications: A license in one of the following is required: Technical Skills:
Required Intermediate Microsoft Outlook
Required Beginner Microsoft Word
Required Intermediate Microsoft Excel
Preferred Beginner SalesForce
Preferred Beginner Xcelys
About us Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses primarily on providing government-sponsored managed care services to families, children, seniors and individuals with complex medical needs primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, as well as individuals in the Health Insurance Marketplace. WellCare serves approximately 5.5 million members nationwide as of September 30, 2018. WellCare is a Fortune 500 company that employs nearly 12,000 associates across the country and was ranked a "World's Most Admired Company" in 2018 by Fortune magazine. For more information about WellCare, please visit the company's website at www.wellcare.com. EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, creed, age, sex, pregnancy, veteran status, marital status, sexual orientation, gender identity or expression, national origin, ancestry, disability, genetic information, childbirth or related medical condition or other legally protected basis protected by applicable federal or state law except where a bona fide occupational qualification applies. Comprehensive Health Management, Inc. is an equal opportunity employer, M/F/D/V/SO.