Provider Network Specialist
CLAIM YOUR FUTURE AS A GREAT PERFORMER!
Providing both satisfying and challenging work along with a highly professional and friendly work atmosphere, Sedgwick has a strong commitment to its colleagues and its clients. If you are seeking a place where you can do great things for those whose lives you touch while maximizing your own career possibilities, Sedgwick is the place for you. As the largest and most innovative Third Party Administrator in the claims industry and the first and only TPA to receive both recognition as the Best TPA in America and the coveted Employer of Choice designation, we invite you to come be a part of our team and, "Claim Your Future."
PRIMARY PURPOSE: To ensure clients and Medical Provider Networks covered employees are provided information on eligibility, coverage, providers, general procedure instructions, and regulations regarding MPN services; and to work with MPN provider on physician credentialing, MPN additions and removals, network and problematic issues.
ESSENTIAL FUNCTIONS and RESPONSIBILITIES
Works directly with clients, program managers, and MPN covered injured workers to ensure they are provided information on eligibility, coverage, provider identification, general procedure instructions, and regulations regarding Sedgwick CMS (company) MPN.
Works with the company Medical Director and vendor partner(s) on physician identification and credentialing processes, MPN provider additions and removals, MPN network issues; makes recommendations for resolution.
Contacts providers to verify new workers' compensation patients are being accepted; tracks credentialing of MPN providers.
Communicates with injured workers relative to the provider pre-designation rules and procedures.
Creates MPN client specific panel cards; maintains MPN matrix as to the status of client's respective MPN.
Communicates with clients relative to their MPN status.
Ensures claims management system parameters are set for MPN flags.
Responds to client and MPN covered injured workers' issues; communicates issues to upper management with solution recommendation as appropriate.
ADDITIONAL FUNCTIONS and RESPONSIBILITIES
Performs other duties as assigned.
Supports the organization's quality program(s).
Education & Licensing
Bachelor's degree from an accredited college or university preferred.
Four (4) years of related experinece or equivalent combination of education and experience required to include three (3) years of customer service and one (1) year of analytical experience. Managed Care experience preferred.
Skills & Knowledge
Thorough knowledge of MPN regulations, practices and procedures
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products
Analytical and interpretive skills
Strong organizational skills
Excellent interpersonal skills
Ability to work independently
Ability to meet or exceed Performance Competencies
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines
Physical: Computer keyboarding, travel as required
Auditory/Visual: Hearing, vision and talking
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
Sedgwick is an Equal Opportunity Employer
Sedgwick Claims Management Services, Inc.