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    Delivery System Coordinator - Jacksonville, United States - Florida Blue

    Florida Blue
    Florida Blue Jacksonville, United States

    2 weeks ago

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    OTHER
    Description

    Florida Blue military SkillBridge Internship

    Are you looking for your next career step after your military service? Are you within 180 days of release from Active Duty? Interested in Network Management experience and healthcare? If so, we may have the perfect opportunity for you.

    Use your extensive professional, leadership, and technical skills to support the company's strategic talent needs. Participation in this program allows service men and women to partake in civilian work where they will receive on the job experience and training in an area that aligns with their interests. Full-time employment opportunities after successful completion of the program may be available.

    Get To Know Us

    The Network Management Department establishes and maintains processes, tools and applications used to administer, operate, and maintain a network structure. We offer competitive salaries and benefits, work-life balance, flexible work arrangements, opportunities for growth and development, and a great place to work across our enterprise

    What Will Be Your Purpose

    The Delivery System Coordinator is to support the contracting process, facilitate necessary paperwork and support key group maintenance for the Network teams.

    Important to Know

    · Remote opportunity

    · Start in May/June

    · You will continue to receive military pay and benefits during this internship.

    What Will You Be Doing

    · The essential functions listed represent the major duties of this role, additional duties may be assigned.

    · Uses computer to research provider participation data, contract terms, language, rates, etc., provider/internal business partner questions regarding network, participation, management plan items.

    · Compile information and prepare reports.

    · Composes and prepares answers to routine inquiries; includes a variety of network and participation related written, verbal, and electronic requests from both internal and external business partners.

    · Supports network staff with clerical requests.

    · Work related to Key Group terminations, additions; collaboration with PPDO, Credentialing and payment team to ensure Key Group data/affiliation detail is accurate and timely.

    · Manages EWOC mailbox for team compliance and reporting. Verbal and written communication is necessary.

    · Upon inquiry from Network team member, provider, member services or any other internal/external business partner, a provider's contract may need to be reviewed for legal, language, rate clarification, date or signatory review, renegotiation, audit, etc.

    · Distribute various documents to the provider, internal business partners (audit or legal); certified letter copies, termination letters, LOIs, payment and language exception forms.

    · Manages EWOC location for team by handling and routing as specified in the business process.

    · Triages the EWOC and either works it to resolution or assigns it to the appropriate team member.

    · Performs Group Roster Validation.

    · Completes the Termination Planning Tool for all terminations.

    · Conducts member moves.

    · Communicates through Blue Squared with other Blue plans.

    · Reviews, certifies, and changes network assignments in various systems.

    · Triages Out of Network Letters of Agreement requests.

    What You Must Have

    · Military members must be within the 180 days (approximately 6 months) of their transition from active duty into the civilian world.

    · An approximate 120-day commitment, though this is flexible depending on the need.

    · Candidates must be comfortable working in a remote setting.

    · Grade E2-E5

    What We Prefer

    · Bachelor's degree in finances

    · Working knowledge of CPT-4 and ICD-9 (Volume I, II and III), HCPCS, revenue codes, medical terminology, insurance terminology, contract terminology.

    · Solid understanding of provider reimbursement methodologies, including, but not limited to, fee for service, per diem, DRG, flat rate, capitation, and discounted fees.

    General Physical Demands

    · Exerting up to 10 pounds of force occasionally to move objects.

    · Jobs are sedentary if traversing activities are required only occasionally.

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

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