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Job Description
Provider Relations Specialist One Call Medical Inc - 3.4 Jacksonville, FL Job Details Full-time $46,700 - $70,100 a year 9 hours ago Qualifications Computer operation Microsoft Outlook Workers' compensation insurance knowledge Full Job Description
JOB SUMMARY
The Provider Relations Specialist is the dedicated Point of Contact for identified providers, either by region or at the organizational level or a combination and is the liaison between the provider and One Call. The PRS will provide ongoing education to our network providers, while regularly monitoring for network compliance, problem-solving provider issues, streamlining internal processes, and relationships, and managing communication between internal departments. The Specialist will be responsible for accurate and timely resolution of Providers' issues. Such issues include, but not limited to; quality improvement, provider remediation, improve cost control while preserving and enhancing a positive Provider/One Call relationship. This position supports business changes to improve the overall Provider business experience with One Call.
ESSENTIAL DUTIES & RESPONSIBILITIES
To initiate proactive outreach and provide ongoing training and education to providers specific to One Call policies and procedures. Manage network complaints including the initial investigation and appropriate follow-up via written and verbal communication, as the situation dictates, while maintaining timely resolutions to the submitting party. Identify patterns of non-compliance, and institute appropriate remediation plans with the goal of improved provider performance. Ability to identify root causes of each reported complaint in order to accurately track and trend non-compliant matters. Act as a liaison for any provider questions and concerns. Prepare and submit monthly reports as part of the proactive provider oversight. Complete Provider Quality and Credentialing (PQC) committee forms, as needed, for monthly presentation to PQC as well as all necessary actions associated with committee decisions. To align with Provider Relations Managers to ensure all provider issues, concerns, and success are well monitored and addressed. Orchestrate conference calls with Providers as well as necessary internal departments in order to rectify issues, enhance Provider education as well as promote positive Provider relationships. Elevate provider relationships to partnerships. Identify mutually beneficial growth opportunities between One Call and providers and coordinate with the appropriate Provider Relations Managers to implement. Special projects as business requirements dictate.
EDUCATIONAL AND EXPERIENCE REQUIREMENTS
Bachelor's degree preferred or the equivalent combination of education, training, and work experience
ESSENTIAL KNOWLEDGE, SKILLS & ABILITIES
Strong critical thinking skills and problem-solving abilities. In-depth knowledge of One Call's products and services, business practices, and processes. Broad knowledge of the workers' compensation industry practices, regulations, and processes. Proficiency in MS Word, Excel, and Outlook. Working knowledge of One Call legacy platforms. Ability to work in an environment that aligns with the company's diversity, equity, inclusion, and belonging standards. Ability to work both independently and in a team environment. Demonstrate our core values of Think Big, Go Fast, Deliver Awe, and Win Together.
PHYSICAL/MENTAL DEMANDS & WORK ENVIRONMENT
This position will be performed in the colleague's home. Work-from-home requirements include the colleague's ability to set up computer equipment within their home office. This job is primarily sedentary and may involve repetitive motions; the colleague must be able to remain in a stationary position for extended periods of time, operate a computer and other office equipment, assess information and files stored electronically, and converse/exchange accurate information with others, simultaneously. The colleague must be able to discern text displayed on a monitor, input data into specific fields using a keyboard, and adjust focus to distances of up to three feet. The colleague must have the ability to learn new tasks, follow established processes, maintain focus, complete tasks independently, complete multiple tasks simultaneously, communicate professionally with colleagues and customers, and complete tasks in situations that have a speed or productivity requirement. The colleague must be able to manage moderate to significant mental stress as a result of, but not limited to, a dynamic and heavy workload. Please be advised that job descriptions typically change over time as business needs, job requirements, and employee skill levels change. As such, One Call retains the right to change or assign other duties to this position at any time.
