Provider Engagement Specialist

4 weeks ago

Miami, United States Little Havana Activities and Nutrition Centers of Dade County Full time
Job DescriptionJob Description

Position Description:

1. Acts as a liaison between claims and credentialing departments.

2. Fields, resolves, and/or escalates issues raised by participating and non-participating providers including, but not limited to, claims inquiries, credentialing updates, complaints, etc. and ensures all issues raised are addressed in a timely and professional manner.

3. Assists Provider Relations Representative with handling high volume of phone calls, emails, and documentation.

4. Reviews paper and electronic claims for Medicaid/Long-Term Care services rendered to participants enrolled with Sunshine Health Plan who are assigned to Little Havana.

5. Provides support to Credentialing Department by communicating with network providers to request documentation and updating database as necessary.

6. Collaborates with Credentialing and Claims departments to complete projects as assigned.

7. Establishes and fosters relationships with network providers and new providers to develop trust, increase organizational presence in the community and increase membership.

8. Arranges and provides training to providers on how to bill using our Provider Claims Portal.

9. Solves issues encountered by providers while processing claims in person, by email or telephonically through our established Provider Hotline.

10. Assists members and/or families in navigating the referral process system as well as providers to ensure all involved are fully educated in rights and benefits.

11. Executes contracts and single case agreements as needed.

12. Maintains quality customer service by following good customer service practices and responding to customer inquiries in a timely and professional manner.

13. Reviews claims and checks status of inquiries and adjustments.

14. Protects operations by keeping claims and provider information confidential.

15. Performs data entry, filing and mailing.

16. Performs other duties as assigned.

 

Minimum Requirements:

1. High School Diploma or equivalent.

2. 2 years’ experience in a similar position.

3. Excellent customer service skills.

4. Strong analytical and organizational skills.

5. Good interpersonal and communication skills.

6. Must have a reliable form of transportation.

7. Must be bilingual (English/Spanish

Company DescriptionCome work for Little Havana Activities and Nutrition Centers of Dade County, Inc., a non-profit organization that serves socially isolated and economically disadvantaged seniors in the South Florida area. At LHANC, we believe in serving with passion and doing the right thing. Our mission is to provide a wide-range of social services to socially isolated and economically disadvantaged seniors in the South Florida area. We identify the need and procure the funding necessary to provide low-income, frail, isolated elderly persons with quality social, nutrition, and health services allowing them to continue to live at home, albeit with some assistance and to avoid early, costlier institutionalization. Our services are all provided to aid the rapidly increasing elderly population with essential services in a loving and sensitive manner. We are a tax-exempt, charitable non-profit corporation that is funded through government grants and private donations.

The Rainbow Intergenerational Learning Center and Child Care Program provides an opportunity for children to develop their maximum potential. The service is offered to working for low-income families. By providing them with access to safe, quality child care services, children of low-income families are prepared to compete on an equal basis with other children of better economic means.
By identifying the obstacles that prevent children from learning, the program enables its children to develop the skills necessary to succeed in their school life.
In addition, parents will find a safe, professional, loving, and culturally sensitive environment for children while they become better informed on issues relative to child rearing.
Rainbow Child Care Services are offered to children between the ages of 0 through 5. This program is offered on a sliding scale fee and subsided services are also available.Company DescriptionCome work for Little Havana Activities and Nutrition Centers of Dade County, Inc., a non-profit organization that serves socially isolated and economically disadvantaged seniors in the South Florida area. At LHANC, we believe in serving with passion and doing the right thing. Our mission is to provide a wide-range of social services to socially isolated and economically disadvantaged seniors in the South Florida area. We identify the need and procure the funding necessary to provide low-income, frail, isolated elderly persons with quality social, nutrition, and health services allowing them to continue to live at home, albeit with some assistance and to avoid early, costlier institutionalization. Our services are all provided to aid the rapidly increasing elderly population with essential services in a loving and sensitive manner. We are a tax-exempt, charitable non-profit corporation that is funded through government grants and private donations.\r
\r
The Rainbow Intergenerational Learning Center and Child Care Program provides an opportunity for children to develop their maximum potential. The service is offered to working for low-income families. By providing them with access to safe, quality child care services, children of low-income families are prepared to compete on an equal basis with other children of better economic means.\r
By identifying the obstacles that prevent children from learning, the program enables its children to develop the skills necessary to succeed in their school life.\r
In addition, parents will find a safe, professional, loving, and culturally sensitive environment for children while they become better informed on issues relative to child rearing.\r
Rainbow Child Care Services are offered to children between the ages of 0 through 5. This program is offered on a sliding scale fee and subsided services are also available.

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