Provider Field Representative - Washington, DC ONSITE

About the role

The Provider Field Representative supports the provider community in various areas including virtual and onsite visits, claims follow-up and research support, as well as virtual and face-to-face training development and delivery. These positions act as liaisons between providers and internal departments.

Responsibilities

• Supports the provider community in a variety of areas including virtual and onsite visits, claims follow-up and research support, and training development and delivery.
• Provides training (workshops, seminars, program specific group events) to the provider community and acts as liaison with internal departments and the customer to implement necessary programs for the Medicaid program.
• Provides one-on-one billing support, claim research and analysis, and targeted outreach to providers; supports provider association inquiries and events.
• Acts as an escalation point for internal claims staff; liaises with internal departments and the client to ensure that all provider concerns are resolved in a timely and efficient manner.
• Applies knowledge of established policies and procedures to resolve provider issues and works with the customer to ensure compliance.
• Exercises independent judgment within defined practices and procedures to define appropriate actions; escalates areas of concern to leadership/the client as defined by procedures; evaluates unique circumstances and makes recommendations.

Requirements

• Three or more years of working in a provider relations or provider contracting role for a health plan in Medicaid or Medicare.
• Medicaid experience preferred.
• Solid understanding of provider operations and key business transactions from a health plan, provider group, or government regulatory perspective.
• Experience working with medical claims processing and claims resolution.
• Strong analytical skills and provider relations skills.
• Excellent communication, presentation, and facilitation skills.
• Some training experience preferred.
• Experience working with business processes.
• Ability to assess clients' business and identify improvement opportunities.
• Ability to conceptualize, develop, and apply business and management consulting applications and services.
• Willingness and ability to travel in the DC Metro area as needed.

Qualifications

• Requires a bachelor's degree in a related field.
• Requires a valid driver's license and reliable transportation.
• Must be able to pass a background check.

Skills

• Complex claims resolutions.
• Strong communication skills.
• Experience delivering training in-person and virtually.
• Local travel in the DC metropolitan area.

Benefits

Gainwell offers a competitive compensation package including a base pay range of $51,700.00 - $73,800.00 per year, a 401(k) employer match, comprehensive health benefits, and educational assistance. Salaried, full-time candidates are eligible for our generous, flexible vacation policy.

Pay

The pay range for this position is $51,700.00 - $73,800.00 per year.

Schedule

Standard business hours Monday through Friday, 8:00 AM to 5:00 PM EST. Occasional flexibility may be required to accommodate provider schedules or special events.