Provider Field Representative - Washington, DC

Summary

The Provider Field Representative, supports the provider community in a variety of areas including but not limited to virtual and onsite visits, claims follow up and research support, as well as virtual and face-to-face training development and delivery. These positions act as liaisons between providers and internal departments. The appropriate individuals for these positions will possess complex claims resolutions, strong communication skills, have experience delivering training in-person and virtually, and be available for local travel in the DC metropolitan area. These positions work with providers, provider associations, and directly with the client in support of the District’s Medicaid programs.

Your role in our mission

• Under minimal supervision, performs routine to complex tasks that are related to provider claiming, program policies, and training.
• Provides training (workshops, seminars, program specific group events) to the provider community and acts as liaison with our internal departments and the customer to implement programs that are necessary for the Medicaid program.
• Provides one-on-one billing support, claim research and analysis, and targeted outreach to providers; supports provider association inquiries and events. Act as an escalation point for internal claims staff.
• Liaise with internal departments and the client to ensure that all provider concerns are resolved in a timely and efficient manner.
• Applies knowledge of established policies and procedures to resolve provider issues, and to work with the customer to ensure compliance.
• Exercises independent judgment within defined practices and procedures to define appropriate actions; escalates areas of concern to leadership/the client as defined by procedures; evaluates unique circumstances and makes recommendations.

What we're looking for

• Three or more years of working in a provider relations or provider contracting role for a health plan in Medicaid or Medicare. Medicaid experience preferred.
• Solid understanding of provider operations and key business transactions from a health plan, provider group, or government regulatory perspective.
• Experience working with medical claims processing and claims resolution.
• Strong analytical skills and provider relations skills.
• Excellent communication, presentation, and facilitation skills. Some training experience preferred.
• Experience working with business processes. Ability to assess clients' business and identify improvement opportunities.
• Ability to conceptualize, develop, and apply business and management consulting applications and services.
• Willingness and ability to travel in the DC Metro area as needed.

What you should expect in this role

• Work from Gainwell’s office in downtown DC, and on-site at provider locations in the DC Metro area.
• Travelling to provider, client, or relevant meetings with up to 60% local travel
• Work standard business hours   Monday through Friday, 8:00 AM to 5:00 PM EST. Occasional flexibility may be required to accommodate provider schedules or special events.

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