Panel Coordinator

Emergent Holdings; Lansing (MI); On-site; USD 42,000 - 66,000; Full time

Job summary

Emergent Holdings is seeking a Provider Panels Coordinator to create, maintain, and update provider panels across multiple states in compliance with state regulations. You will coordinate with agents, insureds, and internal teams to ensure accurate data and timely panel submissions.

Responsibilities include researching providers, validating licensure and NPI details, and expanding coverage where needed, while maintaining confidentiality and adhering to regulatory changes.

Qualifications

• High school diploma or GED with workers' compensation training.
• Minimum three years workers' compensation experience, including two years of demonstrated technical knowledge in a claims or medical environment.
• One year of customer service experience over the phone.
• Ability to research information across multiple systems and websites.
• Knowledge of medical provider specialties and related terminology.
• Familiarity with contracts and governmental regulations.

Responsibilities

• Track production statistics and maintain databases for panels.
• Provide first line contact with physician offices to validate data and acceptance of injured workers panels.
• Respond to inquiries from agents, insureds and brands and send completed panels.
• Create provider panels using Care Analytics or other resources.
• Research and supplement panels with new providers in areas with limited coverage.
• Ensure accuracy and timeliness of provider panels and comply with timelines.

Skills

Medical terminology

Legal terminology

Reading comprehension

Customer service

Problem solving

Education

High school diploma or GED with workers' compensation training

Tools

Excel

Word

Windows

Job description

Job Description

SUMMARY: (Brief 3-5 sentence paragraph outlining the main purpose of the job)

Job Description

SUMMARY: (Brief 3-5 sentence paragraph outlining the main purpose of the job)

The primary responsibility of this role is to create, maintain, and build a repository of provider panels adhering to state specific regulations. This position will submit panels to agents, insured's, and internal customers. Daily contacts include internal staff at all levels, and external customers such as agents, insured and physician offices..

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

• Track production statistics. Develops and maintains, databases and filing systems used for storing panels and postings.
• Provide first line contact with physician offices to validate specialty, demographic information, and acceptance on injured workers at all participating locations.
• Responds to inquiries from agents, insureds and brands, includes answering general questions, accommodating special request and sending completed panels
• Create provider panels using our Care Analytics tool or other available resources.
• Responsible for research using Google, MapQuest and other search engines available on the internet.
• Update provider list for non-panel states.
• Keep up to date with rule changes that impact provider panels in all states.
• Select appropriate physicians by specialty as required by the state regulations.
• Ensure accuracy and completeness of provider panels.
• Meet established timelines for completion of panel request.
• Provide or assist training sessions for team and other business units as necessary.
• Log provider panel requests and monitor timely delivery of panels.
• Research and supplement panels with new providers in areas where there is little to no coverage of preferred providers.
• Monitor provider panel age and update provider panels with new information when expired or within 3 to 6 months from last verification date.
• Work with corporate medical director to assist with certification of MPNs or other network systems required by the state.
• Participate in Medical Review Board to stay current on providers that are not treating to company standards.
• Mitigate risks of fines for inaccurate or missing panel postings.
• Facilitate sharing of panels between brands to minimize redundancy and to consolidate efforts for the enterprise.
• Ensure compliance with statutory changes as they relate to provider panels.
• Maintain confidentiality.
• Verify that licensure and NPI is current for all care analytic physicians being evaluated for use on our panels or postings.
• Responsible for completing special projects as requested by agents, insured and brands. This includes the need for multi-lingual posting or panels.
• Receives returned pharmacy cards and completes necessary follow-up to get the pharmacy card sent out to the injured worker at their correct address.

This description identifies the responsibilities typically associated with the performance of the job. The percentage of time in any responsibility may vary between positions. Other relevant essential functions may be required.

Education And Experience

Relevant combination of education and experience may be considered in lieu of degree.

• EDUCATION REQUIRED: (Brief paragraph detailing the minimum education required, including certifications) Do not state preferred qualifications.

High school diploma or G.E.D required with additional training or college-level course work in workers' compensation or insurance.

• EXPERIENCE REQUIRED: (Minimum experience required to perform this job) Do not state preferred experience.

Minimum three years workers compensation experience, including two years of demonstrated technical knowledge in a claims or medical environment (i.e. applying relevant workers compensation laws, regulations, guidelines, and/or policies) required. One year customer service experience exchanging information and answering and resolving inquiries over the phone required.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Other Skills And Abilities

• Knowledge of medical provider specialties.
• Knowledge of medical terminology and legal terminology.
• Ability to read, analyze and interpret contracts and governmental regulations.
• Ability to establish workflows, manage multiple projects and meet necessary deadlines while maintaining composure during stressful situations occurring as a result of workloads and/or deadlines.
• Ability to research information in multiple systems including various mappings sites.
• Ability to solve problems.
• Ability to work independently in a multi-functional business unit.
• Excellent customer service skills
• Excellent telephone etiquette
• Knowledge of computers, word processing and spreadsheet software with ability to enter accurately at 50 WPM.
• Ability to proofread documents for accuracy of spelling, grammar, punctuation, and format.
• Excellent organizational skills and ability to prioritize work.
• Excellent oral and written communication skills with a high degree of quality and accuracy.
• Knowledge of workers compensation industry
• Ability to establish a rapport and maintain an effective working relationship with both internal and external customers.
• Understanding of enterprise, company, and departmental operations.
• Ability to make competent, independent decisions.
• Ability to take initiative/ownership of the process of creating provider panels.
• ADDITIONAL EDUCATION, EXPERIENCE, SKILLS, KNOWLEDGE, AND/OR ABILITIES PREFERRED: (Briefly detail the preferred education, experience, skills, knowledge, and/or abilities desired to perform this job, including certifications). These are in addition to the required qualifications - Do not state required qualifications.
• Knowledge of multi-state claims processing.
• Experience handling claims in multiple states.
• Industry designation.

REQUIRED TESTING: (For HR use only)

Intermediate Excel, Intermediate Word, Intermediate Windows, Reading Comprehension, 50 wpm and Proofreading

Additional Information

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified. This job description does not constitute a contract for employment.