Provider Services Advocate - Independent Living Systems, LLC : Job Details

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About UsJoin us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources. 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 UsJoin us in making a career in Independent Living Systems, an industry leader in managing home and community-based programs for over 20 years. Independent Living Systems, LLC and its subsidiaries offer a comprehensive range of clinical and third-party administrative services to managed care organizations and providers that serve high-cost, complex member populations in the Medicare, Medicaid, and Dual-Eligible Market. ILS provides tailored integrated solutions aimed at improving health outcomes while rebalancing costs, addressing social determinants of health and connecting members with community-based resources. 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.Position SummaryThe Provider Services Advocate is responsible for responding to Provider telephone inquiries and for identification and elevation of issues to management.Essential Functions

• Provide world class service to our providers by responding to provider issues and inquiries that are received via the telephone.
• Review, research and respond to inquiries from Providers.
• Identify issues based on provider inquiries and elevate those issues management.
• Analyze database to identify problems/ issues pertaining to claim processing.
• Document computer system to track inquiry.
• Meet departmental statistical goals.
• Complete claim adjustments and/or claim processing upon request.
• Complete miscellaneous assignments upon request.
• Maintain production and quality scores as follows:
• Logged In Time: Approximately 08:30:00 hours.
• Not Ready Time: Approximately 01:15:00 hour for breaks/lunches.
• Not Accepted Requeued or Abandoned: Should not exceed total of 0 each day.
• Average Talk Time: Approximately 00:07:00.
• Average Hold Time: Approximately 00:01 :00.
• Quality Average: 95% or greater

Education And Experience

• High School Diploma/GED required.
• College coursework preferred.
• Experience in call center environment, medical background preferred.
• Experience processing UB04 and CMS 1500 claims a plus
• Self-starter, conscientious, independent worker.
• Strong knowledge of Customer Service skills and techniques required.
• Excellent written, verbal, and grammatical communication skills required.
• Ability to read, interpret, analyze technical / business procedures and / or governmental.
• regulations required.
• Ability to write reports, business correspondence and procedural manuals required.
• Knowledge of automated systems (technical adeptness) required.
• Demonstrated proficiency in Microsoft programs (i.e., Excel, Word, PowerPoint) required.
• Microsoft Access knowledge preferred.
• Relevant experience may substitute for the educational requirement on a year-for-year basis

EEO STATEMENTIn compliance with the Drug-Free Workplace Act of 1988, Independent Living Systems has a longstanding commitment to provide a safe, quality-oriented, and productive work environment. Alcohol and drug abuse pose a threat to the health and safety of ILS employees and to the security of the company's equipment and facilities. For these reasons, ILS is committed to the elimination of drug and alcohol use and abuse in the workplace. Independent Living Systems, LLC, and its subsidiaries, including FCC, provides equal employment opportunity to all individuals regardless of their race, color, creed, religion, gender, age, sexual orientation, national origin, disability, veteran status, disability, ancestry, or any other characteristic protected by state, federal, or local law. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Seniority level

• Seniority levelEntry level

Employment type

• Employment typeFull-time

Job function

• Job functionSales and Business Development
• IndustriesHospitals and Health Care

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