Job Description :

 The Provider Enrollment Field Representative will be responsible for supporting provider enrollment including training and working with providers to assist them with enrollment and maintenance related questions.  This position will also conduct site visits of provider locations for medium and high-risk types of providers.

·         Experience with provider enrollment in a health plan/managed care organization is required.

·         Proficiency in English and Spanish is required.

·         Experience related with Provider Services (Credentialing, Claims, Contracting, Site Visits etc.) is required.

 Core Responsibilities

§  Respond to provider requests for assistance by providing onsite training and problem solving, in compliance with the Puerto Rico Medicaid Program.

§  Schedule follow-up activities, such as research, phone calls and onsite visits.

§  Conduct site visits required for enrollment for medium and high-risk provider types.

§  Log, track, and ensure completion of all referrals from internal and external sources in compliance with service standards and policies.

§  Maintain complete confidentiality in handling sensitive enrollment and maintenance issues related with the Puerto Rico Medicaid Program.

§  Ensure  timely and accurate documentation, and provide leadership status reports as requested.

§  Being available to speak with providers and team members when needed during work hours.

§  Achieve a high level of workload volume, ensuring accuracy and compliance with scheduled deadlines.

§  Make recommendations to management to improve the effectiveness and efficiency of the Standard Operating Procedures and any other special projects. 

§  Communicate effectively with the provider community to resolve provider requests that are not submitted according with the Puerto Rico Medicaid Program policy.

§  Complete reports provided by leadership by assigned deadlines.

§  Assist with developing and executing training plans; support the training process; and develop, deliver and evaluate training and support materials.

§  Participate in walkthroughs to review draft training materials and delivery methods.

§  Participate in annual HIPAA security and privacy training.

§  Other duties as assigned by leadership.

    Required Skills

§  Must reside in Puerto Rico

§  Bachelor’s Degree or equivalent work experience

§  Knowledge of Medicaid and or Managed Care Programs

§  Experience with provider enrollment into a health plan/managed care organization

§  Experience with provider services and customer service

§  Strong communication (oral and written), interpersonal, organization skills

§  Experience with Microsoft Office Tools (Word, Excel, PowerPoint, SharePoint, Teams)

§  Fluent in English and Spanish (written and verbal)

§  Ability to travel within the Puerto Rico Region when needed

§  Candidates must be confident with their abilities to make correct decisions and courage to speak out when necessary

§  Willingness and ability to effectively engage with providers and organizations on a continuous basis

§  Requires persistence, demonstrated analytical and problem-solving skills, ability to manage priorities and meet deadlines

§  Excellent analytical and problem-solving skills

§  Strong work ethic and flexibility with an ability to learn quickly

§  Ability to excel in a fast-paced environment with tight deadlines

Preferred Skills

§  Knowledge of Medicaid and or Managed Care Programs

§  Knowledge of and or experience with conducting site visits of provider service locations

§  Experience with providing training

§  Knowledge with problem solving

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