Provider specialist

Job Description

Position Summary :

This position will serve as a primary contact to members whose Primary Care Physician (PCP) terminates with our IPA / Medical Group.

The individual will conduct outbound calls to educate members about the termination of their PCP, assist in identifying a new PCP, and facilitate the PCP change through a 3-way telephone call with the member and member’s health plan.

The individual will ensure members continuity of care is transitioned by taking initiative to coordinate with provider offices, Network Management, and / or Utilization Management as needed.

This position will also serve as a primary contact to members who are calling into our provider line for assistance. The individual will conduct outbound calls to members to retain them under a provider affiliated with RMG / LMG / ADOC.

The individual will be required to facilitate a 3-way telephone call with the member and member’s health plan.

The individual will ensure all member service issues and complaints are handled and resolved to achieve member satisfaction and retention.

Essential Duties and Responsibilities include the following :

• Serve as a primary contact to members whose Primary Care Physician (PCP) terminates.
• Serve as a primary contact to members who disenroll to support retention efforts.
• Facilitate 3-way telephone calls with members and health plans.
• Effectively and accurately educate members about PCP and IPA / Medical Group changes.
• Effectively communicate benefits and services available to members.
• Conduct a minimum of 50-60 outbound answered calls per day.
• Assess and coordinate member’s continuity of care.
• Coordinate appointments, transportation, and interpreter services.
• Liaise with external business partners and internal departments.
• Coordinate and collaborate on assignments and projects.
• Successfully manage multiple assignments and projects within specified timelines.
• Report assignment and project statuses and results to management.
• Accurately document call results in Microsoft Excel and EZ Cap.
• Serve as a resource for members who require assistance.
• Verify and update member demographic information.
• Own overall satisfaction, retention, and success of PCP and Member Termination projects.
• Duties and responsibilities will increase with experience.
• May be required to provide support at offsite location to support retention efforts.
• Any other related duties as assigned by Supervisor and / or VP Network Management.

The pay range for this position at commencement of employment is expected to be between $20 - $22 per hour; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and / or other benefits (including 401(k) eligibility and various paid time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, employee will be in an at-will position and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department / team performance, and market factors.

As one of the fastest growing Independent Physician Associations in Southern California, Regal Medical Group, Lakeside Community Healthcare Affiliated Doctors of Orange County, offers a fast-paced, exciting, welcoming and supportive work environment.

Opportunities abound, and enterprising, capable, focused people prosper with us. We promote teamwork, nurture learning, and encourage advancement for all of our employees.

We want to see you excel, because we believe that your success is our success.

Full Time Position Benefits :

The success of any company depends on its employees. For us, employee satisfaction is crucial not only to the well-being of our organization, but also to the health and wellness of our members.

As such, we are firmly dedicated to providing our employees the options and resources necessary for building security and maintaining a healthy balance between work and life.

Our dedication to our staff is evident in our comprehensive benefits package. We offer a very generous mixture of benefits, including many employer-paid options.

Health and Wellness :

• Employer-paid comprehensive medical, pharmacy, and dental for employees
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-Paid Life Insurance
• Employee Assistance Program (EAP)
• Behavioral Health Services

Savings and Retirement :

• 401k Retirement Savings Plan
• Income Protection Insurance

Other Benefits :

• Vacation Time
• Company celebrations
• Employee Assistance Program
• Employee Referral Bonus
• Tuition Reimbursement
• License Renewal CEU Cost Reimbursement Program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage

Requirements

Education and / or Experience :

• High School Diploma or equivalent required. College Degree preferred.
• Minimum of 3 years of experience at a Health Plan or IPA / Medical Group required.
• Minimum of 2 years experience in a fast-paced call center environment required.
• Prior experience in customer service, member retention, or sales preferred.
• Strong customer service skills.
• Must have excellent telephone etiquette and effective oral communication skills.
• Excellent interpersonal skills.
• Proficient in Microsoft Office. Must know how to navigate and document in Microsoft Excel.
• Analytical and attention to detail skills.
• Strong time management, organizational, and prioritization skills.
• Ability to manage multiple assignments and projects meeting deadlines.
• Ability to work independently with minimal supervision.

Last updated : 2024-03-05