Provider Solutions Advisor IV

Company Name:
Florida Blue
Job Description
Provider Solutions Advisor IV-4946
Job duties include but are not limited to the following:
oResponsible for integrating Provider Service Strategies within the Market and Corporate organizations.
oResponsible for interpreting and trending multiple data sources and information in order to provide direction and facilitation of the resolution of complex issues.
oWorks with assigned markets to understand issues that are being addressed by Network Management and Service.
oProvides subject matter expertise in developing end to end solutions for complex provider issues.
oProvides educational assistance to network management in support of complex provider issues and inquiries.
oCoordinates training/education opportunities to communications team for centralized solutions.
Job Requirements:
oBachelor's degree in business or healthcare management or equivalent work experience
o5+ years of experience working with provider payment programs and contract language
oExperience with medical office process flow and health plan process flow (e.g. billing, claims payment, self-service tools, etc.)
oExperience with insurance/managed care products
oPC skills MS Office applications (Word/Excel/PP)
Business Specific Criteria (preferred skills):
oProject Management Certification (PMP)
oExperience with claims adjudication processes and claim processing systems
oExperience with non-claims issues such as remittance advice, eligibility, benefits, authorizations and referrals
Primary LocationLake Mary
OrganizationBlue Cross Blue Shield of Fla
Posting DeadlineDec 17, 2014, 11:59:00 PM

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