Provider Advocate, Medicare Advantage - CommuniCare Advantage

CommuniCare Advantage is currently recruiting Provider Advocates for our Medicare Advantage health plan. This is a fully remote position that can be based anywhere in our area of coverage, which includes the states of Ohio, Indiana, Maryland, Virginia, and Pennsylvania.

PURPOSE / BELIEF STATEMENT

Provider Advocates are dedicated liaisons for the health plan and its providers. Provider Advocates are responsible for ensuring that providers (individual, group, ancillary, etc.) are set up accurately in the provider information system for reporting, claims payment, and directories. Provider Advocates are also responsible for researching and responding to provider related issues. Provider Advocates directly support the VP, Network and Provider Operations, the Network and Provider Relations Managers, and the Network team.

WHAT WE OFFER

Beyond our competitive wages and Paid Time Off, we offer all full-time employees a variety of benefit options including:

• Life Insurance
• LTD/STD
• Medical, Dental, and Vision 
• 401(k) Employer Match with Flexible Spending Accounts

QUALIFICATIONS / EDUCATION REQUIREMENTS:

Required:

• High School diploma
• 2+ years work experience in health insurance provider relations, provider support, billing, or healthcare office management.
• Expert/Highly Skilled with computer skills: Windows - based applications and Microsoft applications
• Advanced organizational and communication skills
• Function independently and responsibly with minimal need for supervision

Preferred Qualifications: 

• Ability to develop and manage relationships
• Credentialing or Provider Relations experience
• Health plan experience
• Ability to manage multiple priorities
• Understanding of healthcare structures
• Understanding and experience with insurance and/or billing
• Experience in long term care
• Experience with medical terminology 

JOB SKILLS:

• Must have strong oral and written communication skills.
• Must be detail oriented with an ability to work well both independently and in a team setting.
• Strong time management skills required.  Must be able to prioritize and adhere to competing deadlines.
• Must be proficient with computer skills and Microsoft applications. 

PRIMARY RESPONSIBILITIES AND ESSENTIAL FUNCTIONS:

• Research and effectively respond to provider related issues
• Submit provider data entries to resolve provider-related demographic information changes
• Initiate and process provider add, change and termination forms
• Track, update, and audit provider data
• Provide assistance to providers with provider portal registration
• Completes special projects as assigned

Qualified candidates, apply now for a chance to join our outstanding team!

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