Provider Relations Rep, Sr - Atlanta, GA
WellCare - Atlanta, GA

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1202576

About WellCare: WellCare Health Plans, Inc. provides managed care services targeted to government-sponsored health care programs, focusing on Medicaid and Medicare. Headquartered in Tampa, Florida, WellCare offers a variety of health plans for families, children, and the aged, blind, and disabled, as well as prescription drug plans. For more information about WellCare, please visit the Company's website at www.wellcare.com.

Our History: Founded in 1985 with three associates, WellCare grew to more than 800 associates and 467,000 members in Florida, New York and Connecticut by 2002. In 2004, the company acquired Harmony to enter the Midwest and became publicly traded. By 2006, WellCare served 2.2 million members as it became a national prescription drug plan provider and the largest Medicaid plan in Georgia. WellCare expanded its services when it began offering Medicaid managed care plans in Ohio and Missouri in 2007, and Medicare managed care plans in Texas and New Jersey in 2008. Additional growth followed when the company was chosen to serve Hawaii's Medicaid program for the aged, blind or disabled in 2009, and in 2011 when it was selected to serve Kentucky's Medicaid program. Today, WellCare has more than 3,900 associates and approximately 2.4 million members nationwide.

EOE: All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.

Description

DEPARTMENT NAME: Provider Relations

HIRING MANAGER: Sr. Manager, Provider Relations

Manages physician network by developing and maintaining a specific geographic area. Provides service and education to network physicians/providers. Achieves company targets through the implementation of network improvement plans.

Essential Functions:
Completes new provider orientation for all applicable product lines.

Conducts site visits to service providers, resolve issues, educate staff/providers on policies, collect credentialing information, and review HEDIS information.

Achieves call reach and frequency goals to establish consistent and strong relationship with provider offices.

Provides oversight on inquiries and claims issues and follows up with providers to ensure problems have been resolved.

Supports regional Network Improvement Plan targets by providing utilization reports, pharmacy profiles, ER contingencies, Frequent Flier Reports and other analytics available to improve /maintain regions.

Identifies network gaps and complete contracts or work with Network Development.

Understands and explains risk contracts.

Strategizes for membership growth and retention.

Provides training, mentoring and guidance to new representatives.

Special projects as assigned or directed.

Qualifications

Education:
Bachelor's degree preferred or equivalent directly related experience

Experience:
3+ years Provider Relations experience or similar background. 1+ years experience in Medicaid/Medicare. Pharmacy, healthcare, provider or HMO/PPO background preferred.

Special Skills (e.g. 2

nd

language):
Excellent influencing and negotiation skills. Ability to explain complicated financial terms and utilization data to physicians/staff. Excellent written, verbal and public speaking skills. Advanced MS Word and Excel. Knowledge of CMS and state regulations. Excellent written, verbal and public speaking skills. Advanced MS Word and Excel. Ability to understand, interpret and communicate all types of provider and regulatory contracts. Strong knowledge of CMS and state regulations.

Primary Location

GA-Atlanta

Travel

Yes, 75 % of the Time

Is a relocation package available?

No

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About this company
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WellCare knows that to get well, all you need is a little care. WellCare Health Plans provides managed-care administrative services to...