Provider Liaison

2 weeks ago

Orlando, Florida, United States My Florida Corp Defunct Full time
Job Title: Provider Liaison

This is a professional position responsible for independently performing a variety of duties related to quality improvement and enhancement of provider service delivery practices, training and technical assistance, researching provider-related complaints, ensuring providers who are not in compliance submit and follow a plan of remediation which is responsive to cited deficiencies, directing providers to AHCA when billing discrepancies are identified, documenting communication with providers and stakeholders to address identified concerns, collaborating with external stakeholders including the QIO, Medicaid Program Integrity and the Medicaid Fraud Control Unit (MFCU) all while upholding HIPAA requirements.

Key Responsibilities:
  • Review Qlarant reports and identify deficiencies needing correction.
  • Review provider plan of remediation to ensure all deficiencies are remediated within required timeframes and add remediation activities onto the remediation tracker.
  • Follow up with provider to ensure all rights and health and safety alerts are addressed within required timeframes.
  • Follow up on any provider complaints received. Ensure any identified client health and safety issues are immediately addressed.
  • Require plan of remediation for all verified complaints.
  • Conduct wellness visits within 72 hours as assigned for allegations of ANE in APD licensed facilities, ADTs and supported living arrangements using the wellness visit template.
  • Assist in completion of PAARF for request for administrative complaints or provider terminations.
  • Ensure that a Corrective Action Plan is generated for all deficiencies involving APD licensed facilities in annual Qlarant reviews.
  • Collaborate with the APD waiver team and clinical team in researching complaints.
  • Complete other related duties as assigned.
Requirements:
  • High school diploma or its equivalent.
  • Valid Driver's License or other efficient means of transportation.
  • Required travel to community locations and/or offsite meetings for work purposes.
Knowledge, Skills, and Abilities:
  • Knowledge of Microsoft Office Suite Programs (e.g., Excel, Word, SharePoint, Teams).
  • Ability to use APD iConnect System to complete business processes.
  • Demonstrate and provide responsive customer service.
  • Work with individuals with Developmental Disabilities.
  • Multi-task effectively.
  • Use tracking systems to monitor and complete work assignments within required timeframes.
  • Travel to conduct wellness visits, attend provider quarterly meetings and other meetings as assigned.
Additional Information:

Applicants must complete all fields in the Candidate Profile, including their work history with the month and year, to qualify for this position.

Responses to Qualifying Questions must be verifiable in the Candidate Profile, and 'see resume' will not be considered an acceptable response.

Resumes and other documentation can be attached to provide additional information, but these will not replace the required completed Candidate Profile.

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