Managed Care Provider Relations Manager jobs in Wilmington, DE

Summary

A minimum of 1 year’s experience in a call center environment is required. Experience in health/human services and knowledge of Medicaid preferred. Complete pre and post-enrollment site visits according to customer guidelines. Provide excellent customer service primarily by telephone to Medicaid Providers. Assist providers with submission of enrollment applications which includes, appropriate taxonomies, application type, and troubleshooting application process. Follow Customer approved policy regarding submission and processing of enrollment applications. Conduct appropriate research and follow-up for prompt resolution.

Your role in our mission

This is an important position in Gainwell’s commitment to helping clients deliver better health and human services outcomes.

Complete pre and post-enrollment site visits by customer policy. Accurately document the results of the site visit and maintain the record in the provider file. This position will involve travel to provider offices within 50 miles of the Delaware border. Anticipated travel is less than 50%. In addition to completing the site visits, support of the Provider Enrollment call center is expected.

Work efficiently in a high-volume call center while maintaining a professional, polite manner. Assist callers with enrollment-related questions; accurately interpret policy, analyze customer inquiries, and determine steps for resolution. Keep resource information up to date and organized. Document calls clearly and consistently in the computer system. Conduct appropriate research and follow-up for prompt resolution of disputed enrollments. Relay information to appropriate departments and personnel using established communication channels and procedures. Must be able to type and talk at the same time and navigate through multiple screens Ability to maintain confidentiality and adhere to HIPAA requirements. At times, it may be necessary to schedule meetings with providers to assist with the enrollment process.

Process provider enrollment applications within the SLA. Review enrollment applications against customer policy to ensure appropriate enrollment in DMAP programs. Work with the customer to review applications as outlined in the policy.

Promptly respond to written inquiries from providers and customers regarding enrollment questions/concerns.

What we're looking for

• Experience working in a metric-driven work environment.
• Experience using an auto-answer system.
• Experience working in the Healthcare Industry
• Experience working with Medicaid or Medicare
• Experience meeting specific service level agreements (SLAs)
• Experience in provider enrollment or provider credentialing
• 2 or more years of customer service experience in any industry
• Knowledge of basic help desk software, computer software, and Microsoft Office applications
• Strong problem-solving skills to bring inquiries to effective resolution
• Strong customer service skills with an emphasis on written and oral communication to respond to inquiries professionally
• Ability to understand your role on a team and identify the correct stakeholders to consult to resolve client inquiries

What you should expect in this role

• Participates productively as a member of a team.
• Completes tasks beyond the general support level.
• Accepts instruction and direction from leadership. Ability to manage tasks and assignments without detailed direction.
• Identifies, prioritizes, and resolves some issues independently, and escalates more complex questions or issues appropriately.
• Complies with contract requirements, business unit rules, and related legal regulations.
• 50% will be helping the mailroom out when needed.

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