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Provider Outreach Specialist

Job Category: Provider Relations

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Location: Lake Mary, FL, United States

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Job Description

Description

The Provider Outreach Specialist performs outbound calls to providers to ensure compliance with Access & Availability standards in accordance with State regulatory requirements. They are also expected to assist with inbound Provider Service calls as needed during time of peak call intervals and/or unexpected call volume spikes.

  • Make outbound calls to Healthfirst network providers to validate member access to services and existing demographic information currently contained in the Healthfirst Provider Database in accordance with Access and Availability surveys and Provider Spot checks.
  • Record responses and initiate database updates accordingly.
  • Successfully complete Provider Services New Hire Training in order to Provide phone support as needed to the Provider Services Unit during times of peak call volume and/or unexpected call spikes.
  • Compile survey results for distribution to DSE – Delivery System Engagement (Network Management) and Provider Operations. Coordinate printing and mailing of non-compliant letters to corresponding Providers.      
  • Field inbound telephone calls from providers, answer their questions, resolve their problems, escalate issues requiring management intervention, and document all actions.   
  • As needed, complete MACESS Service Form inventory for any Provider Operations/Services folders/workgroups as assigned by management, including completion of new Provider loads or assisting with large ad-hoc data entry projects.   
  • Additional duties as assigned.  

          

Minimum Qualifications:

  • High School Diploma or GED equivalent from an accredited school.
  • Working experience making outbound calls to clients and provide proactive follow up to internal support groups.
  • Working experience working as a liaison with providers and internal support groups. 
  • Working experience meeting deadlines under time sensitive constraints.  
  • Working experience adapting to last minute project requests and changes to existing processes.
  • Working experience working independently with minimal supervision.
  • Working experience in MS Excel utilizing pivot tables, sorting, filtering, manipulating data and documenting follow up results.
  • Working experience navigating through multiple systems and applications at once.

Preferred Qualifications:

  • Associate's Degree from an accredited institution.
  • Working experience in an outbound customer service capacity dealing with direct consumer and/or business to business interactions either over the phone, in-person or written.
  • Customer Service experience in the Healthcare industry and/or at Healthfirst.
  • Working experience as a Provider Services Representative at Healthfirst with a minimum call quality average of 95% or better during past 6 months.
  • Customer Service experience in a Call Center environment.
  • Working experience with Outbound calling campaign's in a Call Center environment.
  • Working experience with MS Excel using Pivot tables.
  • Detailed oriented with organizational skills, with ability to give details in concise manner.
  • SharePoint experience a plus.

Compliance & Regulatory Responsibilities: N/A

License/Certification: NA

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to [email protected] or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

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