Provider Relations Specialist

One Call Medical, Inc., (OCM) is a premier outsourcing organization servicing the Workers' Compensation industry, providing the highest quality scheduling service through its national network of credentialized providers.  We are currently seeking a highly motivated Provider Relations Specialist.

 

SUMMARY

To monitor network compliance, streamline process relationships, provide education and problem-solving to provider and internal operating departments as related to the provider issues.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

 

Provide training and education to providers on OCM policies and procedures.  Schedule a conference call with each newly contracted provider to review OCM policies and procedures prior to the commencement of referrals.

 

Perform site visits of provider facilities in concert with Network Development and Credentialing team members as required.

 

Develop written materials used to communicate with providers including provider manuals, welcome packages, etc.

 

Develop compliance criteria and corrective action plans when a pattern of noncompliance has been identified and not corrected by the provider.

 

Initiate provider information updates in Cactus software system and periodically audit system setups for provider in assigned territories.

 

Provide Sales, Scheduling, Customer Service and other OCM departments with pertinent provider information and educational materials on MRI?s and CT?s and department operations as related to each.

 

Process TIN changes including removal of old center from zip code tables and replacement with another center in consultation with Network Development staff.

 

Resolve issues with centers regarding provision of films to referring physician, patient and others as required.

 

Provide backup of out of network staff as necessary.

 

Serve as the primary interface for questions and inquiries posed by the Accounting staff.

 

Keep abreast of the provider and managed care marketplace in states of responsibility including items such as workers? compensation laws, Certificates of Need regulations, etc.

Keep abreast of fees and requirements offered by competing networks to ensure our competitive status/advantage.

 

Keep abreast of new technology and its potential impact on provider selection and recruitment.

 

Handle network complaints including the initial investigation and appropriate follow-up contact both in writing and on the telephone with the center.  If a pattern of noncompliance or other issues have been established, initiate appropriate compliance measures including zip coding or putting the center in a non-contracted status until the pattern has been corrected.

 

Ensure that all providers have OCM setup as a payor and proper registration processes are in place.  Establish pre-registration process at all contracted hospitals as needed.

 

Act as department liaison for any provider pricing, and provider system update.

 

Serve as the primary interface with the Medical Reports staff regarding non-compliant providers.

 

Responsible for the changes of ownership and closures of existing providers.  For center closures, must obtain appropriate information in order to obtain medical reports and films in the future.  Must notify Finance Department of closure.  Perform replacement of this center in the zip code tables in consultation with Network Development.

 

Prepare and submit monthly reports as required.

 

Serve as the primary interface with staff of the Provider Services team for issues dealing with billing compliance.

 

Perform backup of team members as appropriate.

 

Overnight travel as dictated by department needs and objectives.

 

Provide project leadership on department projects as assigned.

 

Contribute to the positive environment of the team.

 



QUALIFICATIONS



To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

EDUCATION and/or EXPERIENCE 

Bachelor?s Degree (B.A.) from four-year college or university preferred; and two to five years of experience in a managed care organization, preferably in the provider relations/contracting function.

 

LANGUAGE SKILLS

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.  Ability to write routine reports and correspondence.  Ability to speak effectively before groups of customers or employees of organization.

 

MATHEMATICAL SKILLS

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.  Ability to compute rate, ratio, percent, and to draw and interpret bar graphs.

 

REASONING ABILITY

Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.  Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.

 

CERTIFICATES, LICENSES, REGISTRATIONS

None are required.

 

OTHER QUALIFICATIONS

Must be computer literate with experience in a Microsoft Windows environment with proficiency in Word and Excel.

Must have strong oral and written communication skills.

Must have strong organizational skills to ensure tasks are completed in a timely manner.

Must be able to work independently and across the organization to make appropriate decisions.

Must be able to clearly articulate the benefits and requirements of participating in OCM?s provider network and be firm yet fair in dealing with non-compliant providers.

Must have the ability to negotiate win-win relationships.

Must have the ability to work in a fast paced, continuously changing environment with demanding turnaround times.

Must have the ability to use various Internet search engines for required inquiries.

Must be knowledgeable of various provider types, i.e., hospital, ancillary and physicians.

Must have ability to learn and use new software as required.

Must be able to work on several projects simultaneously.

Must have the ability to prioritize multiple assignments.

Must be detailed and accuracy oriented.

Must have the ability to work after hours and weekends if necessary.

Must be able to travel on a limited basis.

 

PHYSICAL DEMANDS  The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

While performing the duties of this job, the employee is regularly required to stand; walk; sit; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; stoop, kneel, crouch, or crawl; and talk and hear.  The employee must occasionally lift and/or move up to 10 pounds. 

 

Please submit your resume with cover letter and salary requirements to employment@onecallmedical.com