Provider Network Specialist jobs in Pensacola, FL

Job Summary
The Service Advocate IV - Network Management is part of a specialized call center who provides education and assistance for contracting, credentialing and Availity issues. This Service Advocate IV role assists the provider in maintenance and directs them on how to request changes to their contract. The position is responsible for providing the group or individual with the tools needed to make the updates via Availity and to give Credentialing data to the groups. The team researches issues and documents the findings, using six or more systems on a daily basis. The position coordinates with multiple departments to correct data discrepancies and provide the group or individual the data needed, if the area cannot assist with the update, i.e. update license in Availity when claims are impacted.

Important to Know: This is a remote position, and this role requires virtual one-on-one training for 3 months. This position is a fast-paced inbound call center supporting our providers with contracting and credentialing issues.

What You Will Be Doing:

• Responsible for providing excellent customer service to provider community through accurate research, education and resolution of telephonic and written provider inquiries and requests.
• Coordinate final resolution of issues with other areas within the organization, i.e. Network Management, Physician Provider Data Operations, Provider Contact Center.
• Support the Network Management contracting process as it relates to initial contracting, re-contracting efforts, terminations, maintenance, and corporate initiatives.
• Work closely with management to identify and complete personal development and continuous improvement opportunities.
• Use web-based tools and other aids to educate and respond to provider inquiries.
• The essential functions listed represent the major duties of this role, additional duties may be assigned.

What You Must Have:
2 years related work experience. Experience Details: in a healthcare or customer service environment

High school diploma or GED

Basic knowledge of HCFA and 1500 claim forms, medical terminology, HCPCS and CPT codes
Excellent verbal and written communication skills; ability to speak in a clear and articulate manner
Basic knowledge of Microsoft applications such as Outlook, Word, and Excel.
Demonstrated ability to develop and strengthen relationships with internal and external business partners
Able to successfully handle multiple tasks and changing priorities
Effectively display a positive attitude and work efficiently in a team environment

What We Would Prefer:

Inbound call center experience
Experience in a health care environment Bilingual in Spanish and English 1 years’ experience with Diamond, Siebel and PIP (Provider Information Platform)

General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.



What We Offer:
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.

To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:

• Medical, dental, vision, life and global travel health insurance;
• Income protection benefits: life insurance, Short- and long-term disability programs;
• Leave programs to support personal circumstances;
• Retirement Savings Plan includes employer contribution and employer match;
• Paid time off, volunteer time off, 10 holidays and two flexible Well-Being days
• Additional voluntary benefits available; and
• A comprehensive wellness program

Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.

To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.

Typical Hourly Pay Range: $18 - $22

Hourly Pay Range: $18 - $29

Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.

We are an Equal Opportunity/Protected Veteran/Disabled Employer committed to creating a diverse, inclusive and equitable culture for our employees and communities.