Summary

Provides quality training and education to the Florida Medicaid provider and health plan communities both virtually and onsite, as required. Knowledgeable in claims processing and adjudication, Medicaid policy, enrollment processes, and health plan policies and procedures. Receives incoming inquiries from a variety of sources, including email, call center escalations, the Agency, and the public Web Portal.  Responds quickly and professionally to Agency, provider, and health plan inquiries with resolutions to problems/issues that may require extensive research. Coordinates with other departments regarding identified system issues and follows through to resolution; this may include, but is not limited to enrollment, claims, and EDI issues. Meets regularly with leadership to review status of escalations/inquiries to ensure timely responses.  Performs other duties as assigned.

Your role in our mission

• Under minimal direction, performs routine and complex tasks related to the support of Florida Medicaid providers. Applies knowledge of established procedures to research and resolve escalated customer questions or management requests. Acts as the initial contact for escalated issues from the support staff and escalates only the most complex issues to the immediate supervisor.
• Researches and analyzes claim processing outcomes, identifies issues and reports as necessary, and proactively outreaches to peers, Supervisor, and/or providers upon findings. Refers questionable claim issues to the appropriate department.
• Provide support to Plan and Provider Specialist peers.
• Facilitates Health Plan Support meetings and supports Call Center staff.
•  Be involved in other provider-related outreach, as needed. Prepares and analyzes administrative reports; makes recommendations to management.
• Examples of work performed may include claims research; new employee training; mentoring other Plan and Provider Specialists by assisting with training and building Client and provider relationships. Performs other support activities and duties as assigned.

What we're looking for

• Great organizational skills and time management habits
• Ability to multi-task
• Excellent verbal and written communication skills (examples include, ability to write clear and concise billing instructions to providers, interpret effects of change orders on systematic claim processing)
• Ability to communicate clearly and professionally with client, management, and peers.
• Attention to detail and quality-oriented

What you should expect in this role

• Autonomy and accountability to shape provider and client experiences in a fast-paced and dynamic environment.
• Hybrid work schedule, working onsite in Tallahassee, FL as scheduled.

• Hybrid (Both remote and office)
• Occasional travel may be required

Employee Benefits & Perks:

• Health benefits (medical, dental, and vision) begin on Day 1 of employment.
• 401(k) with company match and additional benefits become available within the first few months.
• Employees can take advantage of the flexible vacation policy after 90 days of employment. Any exceptions require manager approval before the employee's start date at Gainwell.
• Career growth and advancement opportunities are encouraged and supported.
• A company-provided computer is supplied for work use.

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