Provider Specialist Level III
- Full-Time
Job title
Provider Specialist level 3
Department
Provider Management
Department Head
Kathy Becket
Reports To
Manager, Provider Relations
FLSA Status
Exempt
Last Reviewed
May, 2022
The following statements are intended to describe the general nature and level of work to be performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of an incumbent.
Position Summary
As a Senior Provider Specialist, you will be working closely with multiple provider groups to proactively manage their relationship with MedRisk. The main goal is to provide those groups with better experience with MedRisk and to become not only the first choice network by carriers, but also by providers. In this position, you will work with several departments to help facilitate and develop stronger relationships internally that can improve our network’s experience with Scheduling, Customer Advocacy and claims processing.
Primary Duties & Responsibilities
- Maintain network satisfaction by being the main point of contact for any questions or concerns regarding their participation in the MedRisk Network.
- Work internally with various departments to escalate and address provider issues, disseminate information and communicate updates.
- Increase and update knowledge of the industry and provider community.
- Work with external clients to provide highest level of customer experience and build/maintain strong relationships.
- Identify, monitor, and mitigate potential provider relationship risks.
• Serve as an advocate for the provider in dealing with all internal departments.
- Maintain network database integrity by researching, updating and documenting all systems used to manage network including demographic information, credentialing documentation and contractual information.
- Addressing day-to-day provider inquiries including escalated issues that require more in depth research and knowledge.
- Actively participate on shadowing and mentoring of new team members.
• Be the liaison for MedRisk in resolving contractual disputes and service issues for network providers. This requires investigation, determination of root causes and resolution.
- Strictly adheres to all aspects MedRisk Confidentiality, Privacy and Security Standards Policies and Confidentiality Operating Procedures in performing work. Does not use or discuss MedRisk’s or customers’, providers’, trading partners’ or vendors’ commercially sensitive or privacy-related information, including “PHI” (personal health information)
- Assist with the phone queue as needed
- Proactively discover trends by running reports and research common issues that may affect referral volume and bill processing turnaround times.
- Work on projects as needed identified by leadership.
Qualifications
- Degree in Communications or Business a plus
• Excellent communication, organizational, and problem solving skills.
• Documentation, listening and phone skills.
- Initiative and the ability to troubleshoot and resolve conflict.
- Computer skills including MS Word, Excel, PowerPoint and Outlook.
- High degree of emotional intelligence
- Ability to exercise discretion and professionalism in external communication
Competencies (choose at least 4)
- Customer Focus
- Integrity and Trust
- Functional/Technical Skills
- Listening
- Ethics and Values
- Priority Setting
Working Conditions & Physical Requirements
The work environment characteristics described here is representative of those of a standard office setting. The noise level in the work environment is usually moderate.
While performing the duties of this job, the employee must be able to remain in a stationary position over 50% of the work day; move about inside the office to access files or office equipment; use hands to finger, handle, or feel objects, tools, or controls to operate a computer and other office productivity machines; reach with hands and arms; must communicate and converse with co-workers; and detect/discern information accurately. Specific vision abilities required by this job include close vision and the ability to adjust focus. The employee must occasionally lift and/or move up to 10 pounds.
Employee Statement of Understanding
I have read and understand the job description for my position. I am able to perform all the essential functions of this position.
I agree to comply with the corporate compliance policy and all laws, rules, regulations and standards of conduct relating to my position. As an employee, I understand my duty to report any suspected violations of the law or the standards to my immediate supervisor.
As an employee, I will strive to uphold the mission and vision of the organization. All employees are required to adhere to the values in all their interactions with customers and fellow employees.
Employee Name
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