Medical Access Assistant and Provider Network Coordinator

The RoleThe 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.ResponsibilitiesAssist 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 coverageRelationshipsReports 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.RequirementsExperience/EducationHigh 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/CompetenciesStrong written and verbal / telephone communication skillsBilingual English/Spanish preferredMountain or Pacific time zone preferredAttention to detail a mustExcellent planning and follow-through skillsMust be positive, motivated, and reliableMust be a self-starter, flexible, customer-focused, and have a professional demeanorFamiliar with Microsoft Office applications (Word, PowerPoint, Excel)Highly adaptable and comfortable working in a fast-paced, rapidly-changing environmentSelf-directed and motivated to perform with minimal supervisionProven customer service skills with both internal and external customersPossesses a sense of urgency, sustained drive, and a high energy levelGood listener—able to translate user requests into completed tasksHighly organized and able to manage multiple projects and competing tasks/prioritiesBenefitsPay Range: $20.00 - $26.00Opportunity 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)DentalVisionPaid 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 InsuranceFlexible Spending Accounts (FSA)Employee Assistance Program (EAP)Rise Well Wellness ProgramProfessional Development Reimbursement Program (PDRP)You will be part of our new Elevate program designed to recognize and reward employees for their hard workWe're on YouTube! Check out our culture at: http://www.youtube.com/user/RisingMedical Want to see more? Check out our:Facebook: https://www.facebook.com/RisingMedicalSolutions LinkedIn: http://www.linkedin.com/company/rising-medical-sol.. If you are ready to join a team of professionals dedicated to making a difference and making lives better, please apply today!

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