Provider Services Advocate

We are seeking a 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 Provider Services Advocate plays an essential role in supporting healthcare providers by serving as a liaison between providers and the organization. This position ensures that providers receive timely assistance with inquiries, claims, and service issues, ultimately enhancing provider satisfaction and operational efficiency. The Provider Services Advocate will analyze provider concerns, coordinate with internal departments, and facilitate resolutions to complex problems. By maintaining strong relationships and clear communication channels, the role contributes to the seamless delivery of healthcare services. The ultimate goal is to foster a collaborative environment that supports providers in delivering high-quality member care.

Minimum Qualifications:

• High school diploma or equivalent.
• Two years experience in customer service.
• Knowledge of automated systems and technical adeptness.
• Demonstrated proficiency in Microsoft programs (i.e., Excel, Word, PowerPoint) required.

Preferred Qualifications:

• Associate's or Bachelor's degree in healthcare administration or related field preferred.
• 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 seeking assistance with claims, billing, credentialing, and provider service-related inquiries.
• Investigate and resolve provider issues by collaborating with internal teams such as claims, credentialing, provider relations, and other stakeholders.
• Maintain accurate records of provider interactions, issues, and resolutions to ensure accountability and continuous improvement.
• Communicate policy updates, procedural changes, and relevant information to providers to keep them informed and compliant.
• Identify trends in provider concerns and recommend process improvements to enhance provider experience and operational workflows.
• Perform other duties as assigned.