Professional Health Care Network (PHCN) manages the home health benefit for major insurance plans with the focus on Medicare Advantage and managed Medicaid patients. We review home health care referrals for appropriateness and then set up services with multiple agencies to provide the care needed for patients. On an ongoing basis, we provide review and oversight of clinical care and determine further authorizations.
PHCN is looking for a detailed oriented self-starter to work directly with our Business Relationship Manager to provide exceptional quality care management of home health services. The Provider Service Specialist is responsible for analyzing and problem solving potential issues raised by providers, patients and/or insurance companies. Additionally, this position is responsible for building strong relationships with health plans, home health care agencies all while assisting office staffing coordinators and case managers fulfill incoming request orders.
- Must be knowledgeable about Home Health, orders, and referral documentation
- Must be a problem solver using knowledge of home health and/or utilizing resources within PHCN
- Must be able to listen and communicate potential issues agencies are experiencing.
- Must be able to make decisions in a timely manner and stand firm
- Must be available after regular work hours and on weekends
- Must be able to diffuse situations and work in a fast pace environment with deadlines
- Ability to effectively problem solve and potentially diffuse difficult situations in a timely manner
- Strong communication skills
- Needs to be able to build trust and assurance of getting the job done
- Needs to be able to communicate with every department of the business (on a daily basis) including patients, employees, home health agencies and insurance companies
- Candidate will create a challenging and fulfilling work environment while empowering others to deliver excellent customer service
- Excellent interpersonal skills
- Travel might be required (in and out of state)
- Problem solve issues raised by home health agencies, patients, and/or insurance companies in a timely manner
- Facilitates and assures good communication among administrative staff and referral sources to coordinate best possible home services
- Takes measure to ensure that client care is provided in compliance with Medicare guidelines
- Manages the services that are provided in the most effective and efficient manner possible to best utilize financial resources
- Takes measures to assure care is provided in compliance with all laws and regulations
- Recommends improvement processes for best outcomes
- Carries out assignments and other duties as directed by the management team