Position Description:
1. Acts as a liaison between claims and credentialing departments.
2. Fields, resolves, and/or escalates issues raised by participating and non-participating providers including, but not limited to, claims inquiries, credentialing updates, complaints, etc. and ensures all issues raised are addressed in a timely and professional manner.
3. Assists Provider Relations Representative with handling high volume of phone calls, emails, and documentation.
4. Reviews paper and electronic claims for Medicaid/Long-Term Care services rendered to participants enrolled with Sunshine Health Plan who are assigned to Little Havana.
5. Provides support to Credentialing Department by communicating with network providers to request documentation and updating database as necessary.
6. Collaborates with Credentialing and Claims departments to complete projects as assigned.
7. Establishes and fosters relationships with network providers and new providers to develop trust, increase organizational presence in the community and increase membership.
8. Arranges and provides training to providers on how to bill using our Provider Claims Portal.
9. Solves issues encountered by providers while processing claims in person, by email or telephonically through our established Provider Hotline.
10. Assists members and/or families in navigating the referral process system as well as providers to ensure all involved are fully educated in rights and benefits.
11. Executes contracts and single case agreements as needed.
12. Maintains quality customer service by following good customer service practices and responding to customer inquiries in a timely and professional manner.
13. Reviews claims and checks status of inquiries and adjustments.
14. Protects operations by keeping claims and provider information confidential.
15. Performs data entry, filing and mailing.
16. Performs other duties as assigned.
Minimum Requirements:
1. High School Diploma or equivalent.
2. 2 yearsโ experience in a similar position.
3. Excellent customer service skills.
4. Strong analytical and organizational skills.
5. Good interpersonal and communication skills.
6. Must have a reliable form of transportation.
7. Must be bilingual (English/Spanish
Company Description
Join Little Havana Activities and Nutrition Centers of Dade County, Inc. (LHANC)
Little Havana Activities and Nutrition Centers of Dade County, Inc. (LHANC) is a tax-exempt, charitable non-profit organization dedicated to serving socially isolated and economically disadvantaged seniors throughout South Florida.
At LHANC, we are driven by a strong commitment to service, integrity, and compassion. Our mission is to provide a wide range of social, nutritional, and health-related services that support low-income, frail, and isolated older adults. Through targeted funding and community partnerships, we help seniors maintain their independence, continue living safely at home, and avoid premature and costly institutionalization.
Our programs are designed to meet the growing needs of the elderly population and are delivered with dignity, respect, and sensitivity. LHANC is funded through government grants and private donations and is a licensed TPA vendor for Sunshine Health.