Now Hiring - Healthcare Account Representative in Waukesha, WI

Community Care has adopted a mandatory COVID-19 vaccination policy. This policy requires that all Community Care, Inc. employees verify they are fully vaccinated or have an approved medical or religious exemption.

Community Care is hiring an Account Representative. This rewarding opportunity is perfect for someone who enjoys team collaboration and being part of a mission driven organization. Community Cares mission is to help elderly individuals and adults with physical and intellectual disabilities continue to live as independently as possible in the community. This position is located at our Waukesha location with a Full-time opportunity and weekday schedule.

Account Representative Job Responsibilities:

• Provider Contracting: Completes and coordinates all aspects of provider contracting process for assigned provider group including, preparation of provider agreements for assigned provider groups per established standards, and coordinating and facilitating all processing and credentialing activities to ensure timely execution of agreements.
• Provider Communication: Meets with providers as needed and maintains ongoing communication with assigned providers.
• Provider Data: Maintains data on assigned provider group; creates electronic provider files in the prescribed format; maintains electronic file storage; enters provider notes timely to ensure continuity of agency communication; and collects data forms from providers.
• Provider Management and Network: Assists with reviewing providers in network, provides input on contract decisions, identifies potential providers, ensures appropriate provider coverage for services in which Account Rep is the Account Lead, and consults with management staff on establishing and monitoring provider criteria for inclusion/exclusion in the network.
• Provider Claims/Authorization Analysis: Completes analysis of claims data (paid, denied, billed less paid) and works with provider and internal parties to resolve all issues, completes analysis of authorization issues (unsigned, open, utilization) and works with provider and internal parties to resolve all issues, completes audits and resolves issues related to high cost members or as assigned, and tracks/reports all findings to Director in a timely manner
• Guidelines/Processes: Develops department guidelines and processes for, and maintains, tracks and reports on contracts, LOAs and amendments. Develops department guidelines and processes for, and maintains, tracks and reports on contracts, Letters of Agreement (LOAs) and amendments; Monitors flow of letters of agreement, identifies trends signaling process issues, and reports findings.
• Quality Improvement : Activities Recommends quality improvements related to areas such as contract templates, contracting process, data management and assists in monitoring the provider network for services gaps and advises the Director of Provider Management of findings.
• Provider Training: Provides internal and external training regarding Community Cares requirements and provider expectations. Review existing and create new provider resources. Post, email and distribute to network providers.
• Provider Inquiries/Issues: Researches, analyzes, and responds to provider inquiries, and resolves issues raised by internal staff and external partners.
• Provider Hotline Coverage: Covers provider and AFH hotline as assigned and assists with contract inquiries emails. Assists internal personnel and external partners regarding provider service related issues, gathers appropriate information and forward to the appropriate manager for follow up
• Provider Network Expansion: Researches directories, mailing lists, etc. and does outreach and marketing to non-contracted providers to encourage providers to join Community Cares network in an effort to ensure an adequate network for Gegraphic Service Region coverage
• Directory/Handbook Updates: Gathers information and routinely updates all required provider directories and handbooks

Qualifications and Requirements:
Experience: Required Bachelors Degree A minimum of 1 year of provider relations or customer support experience.
Preferred: 2 years provider relations/customer support experience in health care/insurance environment including exposure to contracting and/or claims .
Occasional Local travel required.

About Community Care Community Care is a local nonprofit with more than 40 years of experience helping older adults and adults with disabilities live as independently as possible within the community. We coordinate and deliver a full range of supportive services that help more than 13,000 Wisconsin residents live safely, confidently, and with dignity. We are Wisconsin-based with local offices supporting each of the 15 counties we serve. Our dedicated team works with members to develop care plans to meet their health and social needs. Together with our community partners, were committed to providing compassionate, personalized care that empowers members to live a healthy and independent lifestyle.

Compensation and Benefits: Our employees make a real difference in peoples lives every day that is why we are proud to offer a compensation package that includes:

• Attractive full and part time schedules
• Generous paid time off
• Competitive pay and benefits (health, dental, vision, etc.)
• Retirement Plan with employer contribution
• Flexible benefits plan
• Employee referral program
• Co-Workers care program
• Employee Assistance Program

COVID-19 Vaccination Policy Community Cares mandatory COVID-19 vaccination policy require all employees to be fully vaccinated or have an approved medical or religious exemption.

Community Care is an Equal Opportunity Employer

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