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Provider Retention Coordinator in Jacksonville, FL at One Call

Date: 9/17/2018

Job Snapshot

Job Description

Provider Retention Coordinator

Entry level professional role. Decisions are made within established policies and standard practices. Learns to use professional concepts. Applies company policies and procedures to resolve routine issues. Has introductory knowledge of company products and services and is assigned to lower-complexity Providers. Normally receives detailed instructions on all work. Typically up to 2 years workers compensation or related healthcare industry experience. Customer service or client management experience – a plus.



Purpose StateMent:

Coordinates activities with One Call’s provider network in alignment with Provider Contracting and Provider Account Management,   and is responsible for timely and accurate resolution of providers’ issues, including those related to initiatives related to improving quality, grievances and provider remediation, improved access and controlling unnecessary costs while preserving positive provider relationships. Supports the implementation of business changes to simplify operations and improve all provider business experiences with One Call.



GENERAL DUTIES & RESPONSIBILITIES:

•         Supports the execution and monitoring of improvements to grievance process

•         Handles and Maintains relationship and needs of Delegated Providers

•         Gathers, analyzes and reports grievances against providers
  • Ensures compliance to policy for timely case resolution

  • Works with providers regarding identifying issues and assisting with development of corrective action plans to facilitate performance improvement

  • May identify and communicate developing trends as to grievances by and against providers

  • May participate in grievance and compliance review meetings to determine disposition of provider status for continued noncompliance or substandard performance

  • Develops, implements and maintains operational processes to meet goals, provider contract requirements, compliance with industry standards and Government mandates

  • Performs Provider Relations triage function; addresses issues raised by providers and routes communications to the appropriate area for handling

  • Coordinates with the Training Unit to conduct education activities involving providers and other departments with the objective to communicate new programs, policies and procedures

  • Coordinates clients’ needs pertaining to providers


 

EDUCATIONAL REQUIREMENTS:

A Bachelor’s degree preferred or the equivalent combination of education, training, and work experience.


GENERAL KNOWLEDGE, SKILLS & ABILITIES:

  • Broad knowledge of One Call’s products and services, business practices and processes

  • In-depth knowledge of the workers compensation industry practices, regulations and processes

  • Experience in Healthcare practice standards

  • Communicates effectively, both verbally and in writing, with individuals inside and outside the company 

  • Exhibit a professional manner in dealing with others and works to maintain constructive working relationships 

  • Strong problem solving abilities and demonstrate the ability to work well under deadline driven environments 

  • Self-motivated