Senior Provider Services Advocate

Job Description

Job Description

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 a critical 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
• Medical background preferred.
• Experience processing UB04 and CMS 1500 claims a plus.
• Proficiency in using healthcare information systems and Microsoft Office Suite.

Preferred Qualifications:

• Associate's degree in Healthcare Administration or related discipline.
• Experience working with managed care organizations or health insurance providers.
• Familiarity with electronic health records (EHR) systems and provider credentialing processes.
• Demonstrated ability to lead projects or initiatives aimed at improving provider services.

Responsibilities:

• Serve as the primary point of contact for healthcare providers, addressing inquiries and resolving issues related to service delivery, billing, and compliance.
• Collaborate with internal departments such as claims, credentialing, and network management to facilitate timely and accurate provider support.
• Analyze provider feedback and operational data to identify trends and recommend process improvements that enhance provider experience.
• Educate providers on organizational policies, procedures, and regulatory requirements to ensure compliance and effective service utilization.
• Manage escalated provider concerns with professionalism and urgency, ensuring resolution aligns with organizational standards and provider expectations.