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Hospital Services Specialist

Wellcare - New York City, NY

Hospital Services Specialist','1800199','!*!About WellCare: WellCare Health Plans, Inc. is a Fortune 500 company traded on the New York Stock Exchange (symbol: WCG). It provides managed care services targeted to government-sponsored health care programs, including Medicaid, Medicare, Prescription Drug Plans and the Health Insurance Marketplace. Headquartered in Tampa, Fla., WellCare offers a variety of health plans for families, children, and the aged, blind and disabled. The company serves approximately 4 million members and employs approximately 6,500 people nationwide as of Sept. 30, 2014. For more information about WellCare, please visit our website at or view our videos at All qualified applicants shall receive consideration for employment without regard to race, color, religion, sex, age forty (40) and over, disability, veteran status, or national origin.','!*!Manages the relationship and all levels of operations support with network hospitals. Provides ongoing education to facilities regarding health plan operations. Identifies and implements process improvements and enhancements.

Department: Provider Relations

Report to: Sr Dir, Provider Relations

Essential Functions:

Establishes and maintains strong business relationships with hospitals in assigned area.

Responds in a timely fashion to identified concerns.

Plans and facilitates hospital meetings as needed.

Designs and implements programs to build and nurture positive relationships between the health plan, providers (hospitals/facilities) and hospital administrators.

Performs provider education through in-service activities and regularly scheduled follow up with providers.

Effectively influences outcomes of key internal and external business issues.

Identifies internal and external operational short-falls and researches and remediates claims.

Executes internal business initiatives (e.g. EDI, EFT/ERA).

Researches, collects and analyzes data on hospitals and other assigned projects.

Designs reports to serve as a basis for decision making on hospital related issues.

Supports effective interdepartmental communication.

Performs other duties as assigned.

Additional Responsibilities:

','!*!Candidate Education:

Required          A Bachelor's Degree in Health Administration, Business or related field

Candidate Experience:

Required           2 years of experience in the managed Care industry with a focus on claims operations and best practices

Required           Other Previous experience working directly with customers

Required           Other In-depth knowledge of Medicare/Medicaid process, rules, regulations and procedures.

Candidate Skills:

Advanced       Demonstrated interpersonal/verbal communication skills

Advanced       Demonstrated written communication skills

Advanced       Demonstrated analytical skills

Advanced       Demonstrated problem solving skills

Intermediate       Ability to work as part of a team

Intermediate       Ability to work independently

Advanced       Ability to represent the company with external constituents Customer relations business acumen

Intermediate       Ability to multi-task Ability to perform a multitude of tasks simultaneously in a fast-paced customer-centered organization

Intermediate       Other Ability to work with less structured, more complex issues

Advanced       Other Critical thinking skills

Intermediate       Other Presentation skills

Intermediate       Other Ability to support project/issue resolution

Licenses and Certifications:

Technical Skills:

Required          Intermediate       Microsoft Word Proficient in Microsoft Office such as Word, Excel, and Outlook

Required          Intermediate       Microsoft Excel

Required          Intermediate       Microsoft Outlook


','US-NY-Manhattan','One New York Plaza','15th floor','New York','10004','','','No','No','Hospital Services Specialist'

7 days 16 hours ago



Hospital Services Specialist Wellcare - New York City, NY, United States


Location: New York City, NY

Company Profile:
WellCare Health Plans, Inc. focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company served approximately 3.8 million members nationwide as of Sept. 30, 2015. For more information about WellCare, please review our website and view the company’s videos. WellCare has developed a full complement of expertise in three major areas of government-sponsored health care…. Medicaid, Medicare Advantage and Medicare Prescription Drug Plans. Leveraging our expertise for our members' benefit is a key part of the value we bring to our members. WellCare focuses on those members who are dually eligible for both Medicaid and Medicare. This is an area of specialization that many other health plans simply do not have. We are committed to continually improving the quality of care and service that we provide to our members. We help our members access the right care at the right time in the appropriate setting. For some members, this includes the use of coordinated care teams and community partnerships. And we’re focused on government customers and use a disciplined approach to ensure a competitive cost structure.