Job Description of Provider Enrollment
o Contacts referring physicians' offices, members, and imaging providers via telephone to communicate authorization approvals, denials, and appeals information for a wide range of medical products, while maintaining confidentiality.
o Recognizes the compliance and regulatory requirements for each health plan and each medical product and assures actions meet these requirements.
o Contacts referring physicians' offices via telephone to verify authorization information, obtain additional clinical information or facilitate a peer to peer consultation between ordering physician and an SBU Physician Reviewer.
o Calls members to support SBU's Facility Scheduling Program.
o Understands the end-to-end authorization process, SBU's business, and business drivers for success.
o Resolves provider or member concerns as the first line of contact.
o Discourages unnecessary clinical/physician phone transfers and encourages medical records to be submitted. Helps callers understand what clinical information is required.
o Transfers calls to clinicians and physicians only for clinically escalated situations.
o Processes withdrawals and other case status change as needed.
o Recognizes and develops relationships with provider groups through repeat calls, and recognizes provider sensitivities for different health plans.
o Responsible for reading and retaining updated account information disseminated through multiple sources. Calls are handled accurately and appropriately per current account information.
o Electronically attaches incoming clinical faxes to authorization requests for medical studies.
o Collects after-hours voice messages, researches questions, triages cases to the appropriate team, and/or return calls as needed.
o Participates in SBU's Customer Care Operations activities as requested that help improve Care Center performance, excellence, and culture.
o Supports team members and participates in team activities to help build a high-performance team.
o Demonstrates flexibility in areas such as job duties and schedule in order to aid SBU's Customer Care Operations in better serving its members and help SBU achieve its business and operational goals.
o Assists SBU efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
o Assumes responsibility for self-development and career progression.
o Responsible for meeting SBU's service standards in all categories on a monthly basis, being a team player, maintaining member and provider confidentiality at all times, demonstrating effective problem-solving skills, and being punctual and maintaining good attendance.
o Other duties as assigned by management.
Medical Recruiting Strategies