Provider Engagement Specialist at One Call in Des Moines, Iowa

Job Description:

Provider Engagement Specialist



We're looking for colleagues who are ready to Think Big, Go Fast, Deliver Awe, and Win Together. These core values embody our diverse and inclusive culture and help us live out our mission of "getting people the care they need when they need it." Over the last 30 years, our company has established itself as the market leader in managed care for the workers' compensation industry. We are committed to making a positive impact in the lives of the injured workers we serve, and we have fun doing it.



Salary Range: 46,700.00 - 70,100.00 Salary


This compensation range takes into account the wide range of factors that are considered in making compensation decisions including but not limited to skill sets; experience and training; licensure and certifications; and other business and organizational needs. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the position may be filled. At One Call, it is not typical for an individual to be hired at or near the top of the range for their role and compensation decisions are dependent on the facts and circumstances of each case. A reasonable estimate of the current range is 46,700.00 - 70,100.00 Salary



Benefits Summary:

In return for your commitment to our company's mission, we offer a vast array of benefits to help support the whole you.

• Opportunities to work from home


• Competitive wages with opportunities to earn annual merit increases


• Paid development hours to use for professional and community development!


• Generous paid time off, 8 company holidays, and 2 floating holidays per year


• $1,000 Colleague Referral Program


• Enterprise Recognition Program rewarding colleagues for their extraordinary work


• Exclusive discounts on travel, activities, and merchandise via work discount program


• Colleague Assistance Program that provides free counseling and financial services


• Tuition Reimbursement Program including certifications


• Quantum Health: A healthcare navigation platform to help our colleagues make the best, most cost-effective healthcare decisions


• Medical, dental, and vision insurance


• Pre-Tax FSA and HSA health savings accounts


• 401(k) matching


• Company paid life insurance


• Company paid short term and long-term disability


• Referral program


• Healthcare concierge


• The One Call Foundation which aims to help colleagues during unexpected emergencies, from car accidents to natural disasters.

The Provider Engagement Specialist will provide ongoing education to our network providers, while regularly monitor for network compliance, problem-solving provider issues, streamline internal process relationships and communication between Provider Contracting, Provider Credentialing, Provider Account Management, as well as Client Services. The Specialist will be responsible for accurate and timely resolution of Providers' issues. Such issues to include, but not limited to; quality improvement, provider remediation, improve cost control while preserving and enhancing a positive Provider/One Call relationship.


GENERAL DUTIES & RESPONSIBILITIES:


Provider Complaints & Engagement (65%)

• 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.
  
  


• Act as a liaison for any provider questions and concerns.
  
  


• Complete Provider Quality and Credentialing (PQC) committee forms for monthly presentation to PQC as well as all necessary actions associated with committee decisions.
  
  


• Special projects as business requirements dictate.
  
  

Education & Collaboration with Stakeholders (25%)

• To provide ongoing training and education to providers specific to OC policies and procedures.


• Collaborate with Account 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.


• Collaborate with Network Quality Government & Risk team to ensure provider policies and protocols are up to date and documented.

Resolution & Network Compliance (10%)

• Identify patterns of non-compliance, institute appropriate remediation plans with the goal of improved provider performance.


• Prepare and submit monthly reports as required.


• Ability to identify root causes on each reported complaint in order to accurately track and trend non-compliant matters.

EDUCATIONAL AND EXPERIENCE REQUIREMENTS:


Bachelor's degree preferred or the equivalent combination of education, training and work experience


GENERAL KNOWLEDGE, SKILLS & ABILITIES:

• Strong critical thinking skills and problem-solving abilities.
  
  


• In-depth knowledge of One Call's products and services, business practices and process
  
  


• Broad knowledge of the workers compensation industry practices, regulations and processes.
  
  


• Proficiency in MS Word and Excel, and Outlook.
  
  


• Working knowledge of One Call legacy platforms.
  
  

PHYSICAL/EMOTIONAL DEMANDS & WORK ENVIRONMENT:

• For roles located in office or home settings, this job is primarily sedentary and may involve repetitive motions; the employee is regularly required to sit, use hands and fingers, speak, and hear.
  
  


• For roles located in the field, this job is primarily active; the employee is regularly mobile and must be able to utilize transportation (such as driving), sit, use hands and fingers, speak, and hear.
  
  


• The employee is occasionally required to stand, walk, and lift objects (up to 10lbs weight; up to 4 ft. height).
  
  


• Specific vision abilities required by this job include ability to see things from a close distance and ability to adjust focus
  
  


• The work environment utilizes florescent lighting; noise level is moderate.
  
  


• The emotional demand of the job may cause undue stress from, but not limited to, moderate/heavy workload.
  
  


• Reasonable accommodations will be individually assessed and possibly made to enable individuals with disabilities to perform the essential functions of the position.
  
  


• Please be advised this job description is subject to change at any time.
  
  

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