Plan and Provider Specialist

As a Plan and Provider Specialist, you will provide quality training and education to the Florida Medicaid provider and health plan communities, both virtually and onsite. You will be knowledgeable in claims processing and adjudication, Medicaid policy, enrollment processes, and health plan policies and procedures. You will receive incoming inquiries from various sources and respond quickly and professionally to Agency, provider, and health plan inquiries with resolutions to problems/issues that may require extensive research.

What You Will Do

Your main day-to-day responsibilities will include researching and analyzing claim processing outcomes, identifying issues and reporting as necessary, and proactively outreaching to peers, Supervisor, and/or providers upon findings. You will also provide support to Plan and Provider Specialist peers, facilitate Health Plan Support meetings, and support Call Center staff.

Why It Might Be a Fit

To be successful in this role, you will need great organizational skills and time management habits, strong detail-oriented skills with an ability to multi-task, and excellent verbal and written communication skills. You will also need to be able to speak English and Spanish fluently, which is a plus.

Requirements

• Bilingual (English and Spanish)
• Great organizational skills and time management habits
• Strong detail-oriented skills with an ability to multi-task
• Excellent verbal and written communication skills
• Ability to speak English and Spanish fluently

Benefits

• 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
• Flexible vacation policy after 90 days of employment
• Career growth and advancement opportunities
• Company-provided computer for work use