In-House Representative Insurance/Healthcare

  • This is a field-based/remote position and the candidate must reside in the Tallahassee, FL area and report to the FMMIS account.
  • Under minimal direction, perform activities involving provider relations, enrollment, policy review, and medical review.
  • Conducts audits to review accuracy of cost reports and payment of claims. Examines claims and reports to ensure proper recording of transactions and compliance with client company policy and/or state and federal regulations. Calculates and maintains records or recoupment. Reviews inquiries from providers regarding cost report settlements.
  • Researches and analyzes claim processing outcomes, identifies issues and reports as necessary, and proactively outreaches to peers, Supervisor, and/or providers upon findings. Refers questionable claim issues to the appropriate department.
  • Conducts visits to Florida Medicaid provider locations for education and training. Creates and delivers formal training, participates in webinars, and is involved in other provider-related outreach, as needed. Prepares and analyzes cost/business proposals and reports of findings; makes recommendations to management.
  • Performs routine and complex tasks related to the support of Florida Medicaid providers. Applies knowledge of established procedures to research and resolve escalated customer questions or management requests. Acts as the initial contact for escalated issues from the support staff and escalates only the most complex issues to the immediate supervisor.
  • Examples of work performed may include claims research; new employee training; mentoring other Provider Field Representatives by performing joint visits, assisting with training, and building Client and provider relationships. Performs other support activities and duties as assigned.

Education and Experience Required:

  • Requires a Bachelor’s degree and a minimum of 1-3 years of Medicaid preferred other Healthcare claims processing experience
  • Previous experience creating and delivering formal presentations
  • Previous team leadership

Desired Skills:

  • Great organizational skills and time management habits
  • Ability to multi-task
  • Excellent verbal and written communication skills (examples include, ability to write clear and concise billing instructions to providers, interpret effects of change orders on systematic claim processing)
  • Ability to communicate clearly and professionally with client and management
  • Attention to detail and quality-oriented

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