Posted on Sep. 30, 2016
Health Insurance, Dental Insurance, Life Insurance, 401K, Disability Insurance
At One Call Care Management we support the Workers Compensation Industry's goal of assisting patients’ maximum rehabilitation and timely return to work! The primary objective of the Patient Care Coordinator Bilingual Spanish is to coordinate patient care as well as delivering the highest customer service for all parties. In doing so you will exercise quality customer service skills, receive referrals and obtain all necessary patient, medical, and demographic information from a variety of referral sources via various communication methods to establish and coordinate medical products and services while utilizing company database to maintain all related and protected patient records.
Are you qualified? Do you have the following?
• High school diploma or GED is required; College Degree (AA / BA / BS) is a plus!
• Successful Customer Service / Retail / Sales work experience required
• Above Average communications and interpersonal relationship skills required ** BOTH: English and Spanish **
KNOWLEDGE, SKILLS & ABILITIES:
• Critical Thinking
• Positive Attitude
• Computer and keyboard
• Flexible / Adaptable
• Active / Continuous Learner
• Call Center / Customer Care
• Communications - Bilingual Speaking/Writing/Grammar ** BOTH: English and Spanish **
* Intake any assigned incoming activity, inclusive of data entry of referrals into patient database (CSRD)
* Address real time service issues and problem solving.
* Triage all incoming requests and meet service level agreements.
* Secure authorization from carrier for all referred products and services .
* Follow all applicable carrier and/or state mandated policies regarding the proper authorization documentation.
* Utilize negotiation skills to assure the most cost effective products and/or services are provided to our customers without sacrificing company quality standards.
* Utilize available resources to research and identify vendors, products, pricing and healthcare information needed to staff referrals in timely manner in accordance with physician orders and customer expectations.
* Create and transmit purchase orders and affiliated documents in accordance with vendor contracted rates, state fee schedules, state rules & regulations, and carrier contracts.
* Partner with Provider Relations to offer consistent feedback on overall performance of National Vendor Network.
* Monitor status of all referrals to confirm successful delivery and/or completion of products and/or services.
* Consistently and effectively update business partners and/or patients regarding status of referrals.
* Communicate effectively with both internal and external customers to assure that all referral needs are met in a timely manner, inclusive of recurring products and services.
* Proactively identify, diagnose, and resolve challenges that may impact the successful delivery of products and services.
* Promote revenue flow by effectively and efficiently advancing all applicable referrals to billing unit for order creation, inclusive of prioritizing all billing related outstanding work orders.
* Support financial aspects of client services cycle inclusive of providing accurate pricing quotes to carriers and assessment of profit margin while adhering to all state fee mandates and company pricing rules.
* Verify and validate the accuracy of all referral information as well as attempt to obtain any missing needed information in order to effectively process referral and invoice carrier.
* In compliance with HIPPA regulations regarding the protection of Personal Health Information (PHI), utilize department mandated format to record all related referral content and activity, inclusive of medical and demographic information, into the company approved time locked database.
* Populate all tracking logs and/or reports; examples include automated call response reports, inventory logs, and task detail tracking related to both outsourced assignments and individual production.
* Acting as a liaison between all internal and external customers, proactively research and resolve outstanding issues in order to foster collaborative relationships.
* Follow internal escalation process when service agreements and/or customer satisfaction is at risk.
* Consistently work with attention given to specific carrier/patient customer preferences, guidelines, and contractual service level agreements.
* Through continuous learning, acquire broad foundation of knowledge
About One Call
No one looks forward to managing a Workers' Compensation claim. It can be a complex, time-consuming and costly experience. You need a partner who understands the process and can provide the expertise and services you require every step of the way. As the nation’s leading provider of specialized cost containment services to the Workers’ Compensation industry, you can count on One Call Care Management to reduce the headaches and hassles and help you achieve faster, more efficient and more cost-effective resolution of claims. From high-end diagnostic procedures, to transportation and language services, to superior dental programs and other medical specialties, One Call is there for you with reliable, consistent connections to care and improved outcomes. With One Call, you’re assured of the highest quality and most cost effective services from impeccably credentialed providers. You can relax knowing that through One Call you receive the finest care in the nation – as quickly as possible.