About the Company:
A Fortune 500 company, is a diversified, multi-national healthcare enterprise that provides a portfolio of services to government sponsored healthcare programs, focusing on underinsured and uninsured individuals. Many receive benefits provided under Medicaid, including the State Children's Health Insurance Program (CHIP), as well as Aged, Blind or Disabled (ABD), Foster Care and Long Term Care (LTC), in addition to other state-sponsored/hybrid programs, and Medicare (Special Needs Plans).
The Company operates local health plans and offers a range of health insurance solutions. It also contracts with other healthcare and commercial organizations to provide specialty services including behavioral health management, care management software, correctional healthcare services, dental benefits management, in-home health services, life and health management, managed vision, pharmacy benefits management, specialty pharmacy and telehealth services.
This position will travel the Iowa City and surrounding counties area.
Perform duties to act as a liaison between providers, the health plan and Corporate including investigating and resolving provider claims issues. Perform training, orientation and coaching for performance improvement within physician practices.
Serve as primary contact for providers serving as a liaison between the provider and the health plan
Conduct monthly face to face meetings with the providers documenting discussions, issues, attendees, and action items researching claims issues on
site and routing to the appropriate party for resolution
Receive and respond to external provider related issues
Initiate entry or change of provider related database information and oversee testing and completion of change request
Investigate, resolve and communicate provider claim issues and changes
Educate providers regarding policies and procedures related to referrals and claims submission, web site education, EDI solicitation and problem solving
Perform provider orientations, including writing and updating orientation materials
Ability to travel
High school diploma or equivalent. Bachelor’s degree in healthcare related field preferred.
3+ years of sales, provider relations, or contracting experience.
Knowledge of health care, managed care, Medicare or Medicaid.
Claims billing/coding knowledge preferred.
Driver’s License may be required by some plans.
Specific language skills may be required by some plans.
License/Certification: Valid driver's license.
The company offers more than just medical insurance. They pay most of your benefits costs and in some cases – they pay 100 percent. Most of the benefits not covered by the company are paid with pre-tax payroll deductions.
Flexible spending accounts (includes health care, dependent care mass transit reimbursement)
Short- and long-term disability insurance
Basic Life insurance
Supplemental life insurance
401(k) retirement with company match
Employee stock purchase plan
Vacation, Personal and Sick time
Paid Company Holidays
Employee Assistance Program (EAP)
Training and Learning Opportunities
Tuition Reimbursement/Educational Assistance
On-site fitness center or discount at local fitness centers (most locations)
Discounts for select local and national products and services, including cell phones, computers and more
Other amenities may be available, but vary by location