Provider Outreach Specialist

Job Snapshot

Job ID: 52619

Location: Latham, NY

Posted: 9/11/2017

Category: Health Care

Experience: At least 2 year(s)

Education: See Requirements

Job Description

About the Position:

We are currently seeking dynamic Provider Outreach Specialists to join our growing team in Latham, NY! The Provider Outreach Specialist will be responsible for negotiating Single Case Agreements (SCAs) for out of network providers and completing tasks related to this function.

The Provider Outreach Specialist must provide complete and accurate information on all inquiries and meet deadlines per established departmental policies. This individual works in several systems simultaneously, handling work queues in the provider, clinical and customer service applications. This individual must meet or exceed established productivity and quality standards. The Provider Outreach Specialist communicates with internal departments and providers via event, inquiry, and in written correspondence.

Position Responsibilities:

  • Initiate SCA requests by taking data from inquiry requests, resolving issues, and responding to questions regarding the request.
  • Conduct follow up protocols on SCA requests to conduct the proper provider/member checks, gather the appropriate provider documentation, negotiation rates if applicable, coordinate with the clinical team to authorize the treatment, execute the SCA and assist with provider data entry and rate loading.
  • Oversee the administration and tracking of all assigned SCAs and coordinate with other teams as needed to facilitate completion of requests.
  • Perform complete investigation and conduct the necessary follow through on all inquiries regarding SCA requests. This includes inquiries related to initial requests, exception requests and follow up requests.
  • Research and accurately respond to inquiries regarding the status of SCAs.
  • Monitor work queue to ensure cases are processed within expected turnaround times.
  • Other duties as assigned.

Position Requirements:

  • Education: High School or equivalent required.
  • Relevant Work Experience: 2 years’ experience in insurance, medical, healthcare or related field required.
  • Knowledge, Skills, Abilities:
    • Professional demeanor, strong written and oral communication skills, strong computer skills, and the ability to learn Beacon’s internal systems.
    • Ability to learn quickly, work independently, make decisions and be resourceful.
    • Detail-oriented, analytical, highly organized and possessing problem-solving skills.
    • Ability to manage varying job pressures, and meet deadlines and handle multiple tasks simultaneously with minimal supervision.
    • Ability to work in a production environment and meet production and quality goals.
    • Ability to work with many levels of staff and management, including technical teams.
    • Computer literacy and experience with Microsoft office programs (Outlook, Word and Excel), and internet searches. Knowledge working with fax machines, copiers and other office machines.

To Apply:

Click below on “Apply for this Position” to create a profile and apply for the position

Beacon Health Options is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment.  EOE/AA/M/F/Veterans/Disabled

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Job Requirements

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  • 5,000 employees nationally and in the U.K.,serving more than 48 million people.
  • My team at Beacon Health Options welcomed me immediately. Collaborating with so many talented individuals within the organization gives me a daily opportunity to see the great work we do in action. - Proposal Specialist, Norfolk, VA
  • Over 350 clients, including 225 employer clients, 45 Fortune 500 companies and partnerships with almost 100 health plans
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