Out Of Network Specialist

Job Overview:

The Out of Network Specialist will perform outreach and consistent follow-up to providers to ensure that there are no gaps in network for members and potential members.

Essential Responsibilities:

• Reaching out to providers, talk about plan, member and continuation of care (sales pitch – most of the times, it’s a matter of how we sell the plan, how convincing and clear we are that makes the provider ok with accepting. With the rare exception of providers just sticking with their policies of only working with straight Medicare etc…)

• Responsiveness is the key

• Passionate, aggressive on closing out the cases

• Following up on pending cases

• Problem solving skill – ex. if can’t get to reach the doctor’s office – google different phone numbers, if intake didn’t provide enough information on the doctor, google search for more information…

·         Multi tasking – doctors offices may leave rep on hold for a long time, ensuring that no time is wasted – entering information in the system while waiting etc.

• Staying positive, not getting discouraged by obstacles that come up, or upset staff/members etc. This is not a repetitive type of job doing the same thing all over again…, rep should be able to handle pressure

• Dealing with emergencies - ex. if member is at appointment and doctor doesn’t want to accept OON insurance, rep should drop everything and work on resolving the matter etc.

• Ability to work on different systems (Sales Force, Tracking Spreadsheets, and Altruista GC) and researching providers on different health websites etc.

Specific Knowledge, Skills, and Abilities:

• Proficient in the use of office equipment and the computer; Microsoft Word and Excel.

• Self-directing, good organizational and interpersonal skills.

• Demonstrates good telephone skills.

• Word Processing/Spread Sheets, Data Entry