Medical Access Assistant and Provider Network Coordinator

The Role

The Medical Access Assistant and Provider Network Coordinator is a position which assists a Rising Payer client with the coordination, roll-out, and ongoing management of their Medical Provider Network (MPN) for workers injured in the state of California.

Responsibilities

• Assist client, client’s policyholders, and injured workers to locate appropriate MPN providers.
• Supports insured and claimant compliance with the State MPN regulations.
• Supports the client’s Claims Examiners by facilitating access to the MPN and with application of MPN regulations.
• Assists injured workers and their representatives to locate providers and to set up appointments as necessary.
• Track requests and maintain logs of activity as required by the CA Department of Workers’ Compensation.
• Identify providers that are no longer seeing workers’ compensation patients, and communicate that information to the appropriate source.
• Manage the providers to be added to the network and to update the listing.
• Use the Rising Network provider search tool to locate providers, look up locations and/or specialties for client, policyholders, and their injured workers.
• As directed by the client Claims Examiner, manage the Transfer of Care and Continuity of Care process for injured workers by sending appropriate notices, arranging treatment within the MPN, and tracking both types of cases to assure that the injured worker has transferred treatment to a Network provider.
• Ensure employer has ample supply of MPN information and has distributed to all employees.
• Assist employers with access and training on the use of the MPN provider search tool .
• Assist client and/or Rising management team with generation of basic reports tracking progress.
• Participate in ongoing training to enhance own job skills, knowledge, and professional growth. Keep informed on issues and trends relating to Healthcare, Workers Compensation, Bill Review, Cost Containment, Managed Care, and related areas.
• Special projects as assigned by client and/or Rising management teams.
• As needed and directed by client, assists claims adjusters in locating appropriate providers.
• Availability to monitor and respond to calls and emails on Saturdays as part of scheduled service coverage

Relationships

• Reports to - Compliance Department (Rising); receives day-to-day guidance from Compliance Manager.
• Regularly interacts with members of the Rising Account Management and Medical Review Unit Teams, Clients, Injured Workers, and Providers.

Experience/Education

• High school diploma required; two or four year college degree preferred.
• Prior customer service experience, preferably in workers compensation or managed care role.
• Telephone, telemarketing, CRM experience.

Skills/Competencies

• Strong written and verbal / telephone communication skills
• Bilingual English/Spanish preferred
• Mountain or Pacific time zone preferred
• Attention to detail a must
• Excellent planning and follow-through skills
• Must be positive, motivated, and reliable
• Must be a self-starter, flexible, customer-focused, and have a professional demeanor
• Familiar with Microsoft Office applications (Word, PowerPoint, Excel)
• Highly adaptable and comfortable working in a fast-paced, rapidly-changing environment
• Self-directed and motivated to perform with minimal supervision
• Proven customer service skills with both internal and external customers
• Possesses a sense of urgency, sustained drive, and a high energy level
• Good listener—able to translate user requests into completed tasks
• Highly organized and able to manage multiple projects and competing tasks/priorities

• Pay Range: $20.00 - $26.00

• Opportunity to make a difference in reducing health care costs and increasing the value of health care to individuals and their employers.
• Daily interaction with some of the most talented people in the medical cost-containment industry.
• Health insurance (4 different plans to choose from)
• Dental
• Vision
• Paid time off (PTO) or Flexible Time Off (FTO)
• 401(k)
• Basic Life Insurance and Long-Term Disability Insurance (paid by the company)
• Voluntary Life Insurance and Short-Term Disability Insurance
• Flexible Spending Accounts (FSA)
• Employee Assistance Program (EAP)
• Rise Well Wellness Program
• Professional Development Reimbursement Program (PDRP)
• You will be part of our new Elevate program designed to recognize and reward employees for their hard work
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If you are ready to join a team of professionals dedicated to making a difference and making lives better, please apply today!