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Provider Support Coordinator in Jacksonville, FL at One Call

Date: 9/17/2018

Job Snapshot

Job Description

Provider Support Coordinator

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

•         Serves as the point of contact for the provider appeals process

•         Gathers, analyzes and reports grievances against providers
  • Supports development and implementation of policy changes and communicates the provider perspective when representing the department on cross-functional teams, corporate initiatives and tactical objectives

  • Actively conducts provider outreach that may include telephonic, face-to-face or via email; and, also engagement activities to meet One Call’s business needs, gain market intelligence, and maintain positive network relationships

  • Facilitate training and support for provider portal usage.

  • Institute Corrective Action Plans, Probations and Disciplinary actions

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

  • Completes PQC forms as well as completes PQC follow up of actions taken with the provider

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

  • 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