Provider Services Coordinator (Outbound)

Your Future Evolves Here
Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Evolenteers make a difference wherever they are, whether it is at a medical center, in the office, or while working from home across 48 states. We empower you to work from where you work best, which makes juggling careers, families, and social lives so much easier. Through our recognition programs, we also highlight employees who live our values, give back to our communities each year, and are champions for bringing their whole selves to work each day. If you’re looking for a place where your work can be personally and professionally rewarding, don’t just join a company with a mission. Join a mission with a company behind it.
Why We’re Worth the Application:

• Recognized as a leader in driving important diversity, equity, and inclusion (DE&I) efforts.
• Named to Parity.org’s list of the best companies for women to advance for 3 years in a row (2020, 2021 and 2022).
• We continue to grow year over year.
• Continue to prioritize the employee experience and achieved a 90% overall engagement score on our employee survey in May 2022.
• Achieved a 100% score two years in a row on the Human Rights Campaign's Corporate Equality Index recognizing us as a best place to work for LGBTQ+ equality.
• Publish an annual DE&I report to share our progress on how we’re building an equitable workplace.

What You’ll Be Doing:
This position primarily handles outbound call queues for designated clients related to authorization processing for multiple medical specialties and products. This may include notification calls to ordering physicians, imaging facilities and members, as well as other benefit related calls. This position is held accountable for meeting individual productivity and quality metrics and working with a team to meet compliance and timeliness targets for our clients. This role is cross trained in inbound functions and provides back up support to Customer Care Associates as required.

• Assists with researching unmatched or errant faxes to protect member PHI and identify system issues and training opportunities for team members.
• Works timeliness reports and CAPS report email.
• Makes outbound calls to members to support SBU's Facility Scheduling Program.
• Transfers calls to clinicians and physicians only for clinically escalated situations.
• Discourages unnecessary clinical/physician phone transfers and encourages medical records to be submitted. Helps callers understand what clinical information is required.
• Recognizes the compliance and regulatory requirements for each health plan and each medical product and assures actions meet these requirements.
• Documents every outreach call with appropriate actions and notes to support contracted and compliance requirements and clarity about each interaction or attempt to interact.
• Resolves provider or member concerns as the first line of contact.
• Contacts referring physicians' offices, members and imaging providers via telephone to communicate authorization approvals, denials and appeals information for a wide range of medical products, while maintaining confidentiality.
• Manages Coordinator Help Inbox to resolve non-standard case issues.
• Understands the end-to-end authorization process, SBU's business and business drivers for success.
• Assumes responsibility for self-development and career progression.
• Meets SBU's service standards in all categories on a monthly basis, being a team player, maintaining member and provider confidentiality at all times, demonstrating effective problem-solving skills, and being punctual and maintaining good attendance.
• Collects after hours voice messages, research questions, triages case to the appropriate team and/or return calls as needed.
• Recognizes and develops relationships with provider groups through repeat calls and recognizes provider sensitivities for different health plans.
• Reads and retains updated account information disseminated through multiple sources. Calls are handled accurately and appropriately, aligned with current health plan and internal policy requirements.
• Assists SBU efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies.
• Demonstrates flexibility in areas such as job duties and schedule in order to aid SBU's Customer Care Operations in better serving its members and help SBU achieve its business and operational goals.
• Processes withdrawals and other case status changes as needed.
• Other duties as assigned by management.
• Electronically attaches incoming clinical faxes to authorization requests for medical studies.
• Contacts referring physicians' offices via telephone to verify authorization information, obtain additional clinical information or facilitate a peer-to-peer consultation between ordering physician and a SBU Physician Reviewer.
• Supports team members and participates in team activities to help build a high-performance team.
• Requests to clear notifications manually as part of daily timeliness efforts to meet Performance Guarantees.

HSD Or Equivalent Required.
Preferred Experience We Look For:

• Customer Service in Healthcare experience.
• Minimum 1 year of Customer Service experience.
• Experience with computer and keyboard use while talking and typing (minimum 35 WPM) simultaneously.
• Knowledge of medical terminology.

Technical Requirements:
We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.
Evolent Health is an equal opportunity employer and considers all qualified applicants equally without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, or disability status.
Compensation Range: The minimum salary for this position is $$17.50, plus benefits. Salaries are determined by the skill set required for the position and commensurate with experience and may vary above and below the stated amounts.