• Job Description

  Req#: 32147
  Get to know us!
  
  Florida Blue, a GuideWell Company, has been providing insurance to residents of Florida for 75 years. Driven by its mission of helping people and communities achieve better health, the company serves more than five million healthcare members across the state.
  
  We are looking for exceptional people who will bring our mission to life and succeed by putting the member first.
  
  Let's talk benefits!
  
  When it comes to our benefits, we offer a total compensation package including competitive base pay, health insurance, 401(k), as well as work-life balance programs, flexible work arrangements, and opportunities for growth and development. We design our offerings to take care of you-to help you be your best at work and in life.
  
  What you will do:
  
  Specialists apply discipline-specific or institutional knowledge with accountabilities of highly complex provider escalations across the state. This role is provider facing and will work directly with executives and/other internal teams to assist with the communications of issue and escalation resolutions back to providers. This role requires extensive knowledge and understanding of network reimbursement, claims processing and account receivable methodologies. Incumbents may directly manage a small number of direct reports: the primary role is applying specialized knowledge and skills as an exempt-level individual contributor.
  
  The Specialist is accountable for ensuring enterprise-wide provider escalations are identified, tracked, managed, and resolved within established timelines to manage and mitigate risks to the Florida Blue network, brand and with regards to Federal and State compliance guidelines.
  
  Important to know:
  
  While the role is currently 100% remote, onsite provider meetings may be required in the future.
  
  The essential functions listed represent the major duties of this role, additional duties may be assigned:
  • Serving as a mentor to analyst, the Specialist will train, mentor and coach less experienced analysts on the technical and interpersonal skills needed for effective job performance.
  • Serves as an expert lead to critical and complex provider escalations as the health care industry transforms to impact improved performance outcomes. The specialist provides oversight for escalations intake, tracking, trending, and data reporting. As the expert lead, they will identify and support continuous improvement initiatives and provide subject matter expertise at external hearings, mediations, audits, and internal meetings/workgroups.
  • Contributes to short- and long-range planning and development by using continuous improvement methodologies to define escalation root causes and work with internal teams for provider process improvement implementations and ensure through audits that the organization's programs are consistently administered in compliance with the organizational policies and contractual obligations. Influences key stakeholders to advocate for and adopt effective provider business processes, initiatives and capabilities including recommending improvements to achieve and deliver high-quality value-added services
  • Prepares documentation including developing, tracking, and updating provider documentation, status reports, tracks, and updates project plans. Creates SQL and Kibana reports for executive team and strategic providers that establishes and provides oversight of provider operating policies and claims escalation updates on aged inventory.
  • Create, present and/or facilitate escalation meetings across the state, webinars, conference calls for a variety of internal and external audiences.
  
  What you will need:
  
  Experience:
  • 5+ years of Health care experience with a focus on provider escalations, network management or provider office/hospital environments.
  
  Preferred experience:
  • Experience in preparing and presenting training materials.
  • Experience in negotiating and influencing customer outcomes.
  • Experience with managing a territory and associated priorities, action plans and tasks.
  • Experience with collaborating and building relationships with multiple internal and external partners such as vendors, providers, etc.
  • Experience developing and implementing strategic plans and reports.
  • Experience managing complex AR and complex claims.
  • Knowledge of MS Office applications including Word, PowerPoint, and Excel.
  • Knowledge of all payment methodologies/contracts, (e.g., physician/provider, ACFS, drug, per diem, OPP, DRG, etc.)
  
  Education:
  • Related Bachelor's degree or additional related equivalent work experience
  
  General Physical Demands:
  Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
  
  What We Offer:
  As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.
  
  To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
  
  • Medical, dental, vision, life, and global travel health insurance.
  • Income protection benefits: life insurance, Short- and long-term disability programs.
  • Leave programs to support personal circumstances.
  • Retirement Savings Plan includes employer contribution and employer match.
  • Paid time off, volunteer time off, and 11 holidays
  • Additional voluntary benefits available; and
  • A comprehensive wellness programs
  Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
  
  To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
  
  Annualized Salary Range: $72,300 - $117,500
  
  Typical Annualized Hiring Range: $72,300 - $90,400
  
  Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring. We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive, and equitable culture for our employees and communities.

• About the company

  The best remote jobs for you

Notice