Senior Provider Services Advocate

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Full Time Miami, FL, US

17 days ago Requisition

We are seeking a Senior Provider Services Advocate to join our team at Independent Living Systems (ILS). ILS, along with its affiliated health plans known as Florida Community Care and Florida Complete Care, is committed to promoting a higher quality of life and maximizing independence for all vulnerable populations.

About the Role:

The Senior Provider Services Advocate plays an essential role in ensuring seamless communication and collaboration between healthcare providers and the organization. This position is responsible for advocating on behalf of providers to resolve complex issues related to service delivery, billing, and compliance, thereby enhancing provider satisfaction and operational efficiency. The role requires a deep understanding of healthcare systems, provider needs, and regulatory requirements to effectively support and guide providers through various processes.

By serving as a liaison, the Senior Provider Services Advocate helps to foster strong, productive relationships that contribute to improved member care outcomes. Ultimately, this position drives the continuous improvement of provider services by identifying challenges and implementing strategic solutions.

Minimum Qualifications:

• High School Diploma/GED required
• Two years experience in customer service.
• Knowledge of automated systems and technical adeptness.
• Demonstrated proficiency in Microsoft programs (i.e., Excel, Word, PowerPoint).

Preferred Qualifications:

• Associate's degree in Healthcare Administration or related discipline.
• Experience working with managed care organizations or health insurance providers.
• Experience working with Medicaid, Medicare, or commercial insurance providers.
• Experience processing UB04 and CMS 1500 claims
• Familiarity with healthcare regulatory requirements and compliance standards.
• Certification in healthcare customer service or provider relations.
• Demonstrated ability to use data analytics tools to identify trends and support decision-making.

Responsibilities:

• Demonstrate commitment to Our Mission and models ILS Experience Standards of Excellence.
• Serve as a primary point of contact for healthcare providers, addressing inquiries and resolving issues related to claims, billing, credentialing and compliance.
• Collaborate with internal teams such as claims, credentialing, provider relations, network management and other stakeholders to facilitate timely and accurate provider support.
• Document and handle escalated provider concerns with professionalism and urgency, ensuring resolution aligns with organizational standards and provider expectations.
• Educate providers on organizational policies, procedures, and regulatory requirements to ensure compliance and effective service utilization.
• Analyze provider feedback and operational data to identify trends and recommend process improvements that enhance provider experience.