Panel Coordinator

About the role

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, insureds, and internal customers. Daily contacts include internal staff at all levels and external customers such as agents, insureds, and physician offices.

Responsibilities

• Track production statistics.
• Develop and maintain databases and filing systems used for storing panels and postings.
• Provide first-line contact with physician offices to validate specialty, demographic information, and acceptance of injured workers at all participating locations.
• Respond to inquiries from agents, insureds, and brands, including answering general questions, accommodating special requests, and sending completed panels.
• Create provider panels using the Care Analytics tool or other available resources.
• Conduct research using Google, MapQuest, and other search engines available on the internet.
• Update provider lists for non-panel states.
• Stay up to date with rule changes that impact provider panels in all states.
• Select appropriate physicians by specialty as required by state regulations.
• Ensure accuracy and completeness of provider panels.
• Meet established timelines for completion of panel requests.
• Provide or assist in training sessions for the 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 the last verification date.
• Work with the corporate medical director to assist with certification of MPNs or other network systems required by the state.
• Participate in the 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 consolidate efforts for the enterprise.
• Ensure compliance with statutory changes as they relate to provider panels.
• Maintain confidentiality.
• Verify that licensure and NPI are current for all care analytic physicians being evaluated for use on panels or postings.
• Complete special projects as requested by agents, insureds, and brands, including multi-lingual postings or panels.
• Receive returned pharmacy cards and complete necessary follow-up to ensure the pharmacy card is sent to the injured worker at their correct address.

Requirements

High school diploma or G.E.D required with additional training or college-level coursework in workers’ compensation or insurance.

Minimum three years of 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 of customer service experience exchanging information and answering and resolving inquiries over the phone required.

Skills

• 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.
• Ability to research information in multiple systems, including various mapping sites.
• Problem-solving skills.
• Ability to work independently in a multi-functional business unit.
• Excellent customer service skills and telephone etiquette.
• Proficiency in computers, word processing, and spreadsheet software with the ability to type 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 the workers compensation industry.
• Ability to establish rapport and maintain effective working relationships with both internal and external customers.
• Understanding of enterprise, company, and departmental operations.
• Ability to make competent, independent decisions.
• Ability to take initiative and ownership of the process of creating provider panels.