Provider Management Support Specialist

Community Care is hiring a Provider Management Support Specialist. This rewarding opportunity is perfect for someone who enjoys team collaboration and being part of a mission driven organization. Community Care's mission is to help elderly individuals and adults with physical and intellectual disabilities continue to live as independently as possible in the community.
Provider Management Support SpecialistJob Specific Responsibilities:

• • Supports the provider during the initial application process. Ensures all needed documents are included with the application.  Notifies provider of submission deadlines for any discrepancies.
  • Responds to provider questions or refers them to the appropriate person for follow up.
  • Maintains data on assigned provider group; creates electronic provider files in the prescribed format; maintains electronic file storage; enters provider notes timely to ensure continuity of agency communication; and collects data forms from providers.
  • Assists with reviewing providers in network, ensures information is correct and up to date.
  • Maintains, tracks and reports on contracts, LOAs and Amendments. Monitors flow of letters of agreement, identifies trends signaling process issues, and reports findings to Manager.
  • Recommends quality improvements related to areas such as application process, contracting process, data management and assists in monitoring the provider network for services gaps and advises the Manager of findings.
  • Assists with internal and external training regarding Community Care's requirements and provider expectations. Post, email and distribute to network providers.
  • Researches, analyzes, and responds to provider inquiries, and resolves issues raised by internal staff and external partners.
  • Covers provider hotline as assigned and assists with contract inquiries emails. Assists internal personnel and external partners regarding provider service related issues, gathers appropriate information and forward to the appropriate manager for follow up.
  • Gathers information and routinely updates all required provider directories and handbooks.
  • Performs other job-related duties as assigned.

Provider Management Support Specialist Job Requirements:

Education: High School Diploma or Equivalent 

Experience: 

Required A minimum of 1 year of provider relations or customer support experience.

Preferred

2 years provider relations/customer support experience in health care/insurance environment including exposure to contracting and/or claims.

Excellent attention to detail. Proficiency in word-processing and spreadsheet software, preferably using Microsoft Applications. Familiar with and able to operate and maintain office equipment including computer printers, copiers and fax machines.

Monday to Friday, 8:00 AM-4:30 PM

About Community Care

Community Care is a local nonprofit with more than 40 years of experience helping older adults and adults with disabilities live as independently as possible within the community. We coordinate and deliver a full range of supportive services that help more than 13,000 Wisconsin residents live safely, confidently, and with dignity. We are Wisconsin-based with local offices supporting each of the 15 counties we serve Our dedicated team works with members to develop care plans to meet their health and social needs Together with our community partners, we're committed to providing compassionate, personalized care that empowers members to live a healthy and independent lifestyle.

Compensation and Benefits:

Our employees make a real difference in people's lives every day. That is why we are proud to offer a compensation package that includes: