Job Description
Job Description
Department: Nexus
Location: 1500 Expo Parkway
Reports to: Director, Payor & Provider Networks
Status: Full Time
FLSA:Non-Exempt
Pay Range: $22.64 - $29.43/hr
EEO-1: Administrative Support Worker
Organization Information
WellSpace's mission is "achieving regional health through high quality comprehensive care." We believe that everyone deserves to be seen, no matter who you are, where you come from, where you work or what place you call home. At WellSpace, we see you!
We are driven to serve the whole person through comprehensive, integrated care, spanning medical, dental, behavioral health, and supportive services across the region. We do this by building a team of exceptional colleagues who are dedicated to our mission and becoming part of the communities we serve.
As the region's largest Community Health System, WellSpace utilizes a Confluence Model to integrate an internal network of healthcare modalities, including Federally Qualified Health Centers (FQHC), Certified Community Behavioral Health Center (CCBHC), Drug Medi-Cal and Specialty Mental Health programs, California's second largest 988 Suicide and Crisis Lifeline Center, an independent Risk Bearing Organization (WellSpace Nexus), and more into a seamless confluence of care.
To ensure the highest quality of care, WellSpace is accredited by the Joint Commission for Ambulatory Care, Behavioral Health and as a CCBHC. Further, it is certified by the Joint Commission as a Primary Care Medical Home and a Behavioral Health Home. WellSpace's crisis programs are accredited by the American Association of Suicidology and the International Council for Helplines.
Position Summary
The Provider Network Ambassador will serve our provider network to analyze and resolve a variety of provider network issues including claims, authorizations, referrals and other related items. The Provider Network Ambassador will work to resolve issues accurately and timely.
Required Qualifications
- High School diploma or equivalent required.
- Minimum 1-year healthcare experience within a medical group or health plan.
- Communicate clearly and concisely, both verbally and in writing and demonstrate a high level of listening skills.
- Proficient use of computer software including Microsoft Office Suite
- Experience working interdepartmentally to research external provider issues.
- Understanding of Medi-Cal, Medicare, and commercial insurance, Medical Groups/IPAs and health plans.
- Strong administrative skills with attention to detail.
- Business and analytical problem-solving skills
- Ability to work independently.
- Ability to abide by standards of professional ethics and maintain HIPAA rules of confidentiality.
- Adherence to infection control procedures, including but not limited to, standard precautions of temperature monitoring, hand washing, symptom self-monitoring, masking and social distancing.
- Assist and support the Center/Department/Program to meet standards of High Reliability.
Essential Responsibilities
- Answer telephone calls using an automated system and responds to general to moderately complex questions and/or engages/interfaces with appropriate departments for resolution.
- Record calls in the portal ticketing module, resolve provider network requests/inquiries and update ticket.
- Conduct outbound calls to research/follow-up and provide resolution to provider issues.
- Work failed claims queue to ensure claims are resolved in a timely manner.
- Research member eligibility and make appropriate updates in Nexus portal.
- Load/update organization and provider information in Nexus portal.
- Update member eligibility in Nexus portal.
- Manage user access to Nexus portal.
- Log and track provider network issues via Nexus Portal.
- Connect callers with leadership as needed.
- Maintain up-to-date knowledge of Medi-Cal regulations and policies as they apply to the various programs we service.
- Create workflows and desk level procedures.
- Assist Experience Ambassador as needed.
- Complete all assigned training as necessary.
- Other duties as assigned.
Benefits
Successful candidate will receive regionally competitive salary, above average health benefits at reduced costs, company paid life insurance & long-term disability insurance, additional voluntary retirement plan with company match and no vesting schedule requirement.
- Paid bereavement and jury duty leave
- 11 paid holidays per year
- Paid time off
- Paid sick leave
- Flexible Spending Program
- Company paid malpractice insurance for all providers
- Professional development hours offered annually
Physical Demands and Work Environment
The work environment is characteristic of a medical clinic environment. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is frequently required to sit; use hands to handle, or reach. The employee is also required to stand; walk; and reach with hands and arms. The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, and the ability to adjust focus. The employee must also possess hearing and speech to communicate in person and over the phone. The noise level in the work environment is usually quiet.
The employee may be in contact with individuals and families in crisis who may be ill, using substances and/or not attentive to personal health and safety for themselves or their homes. The employee may experience a number of unpleasant sensory demands associated with the client’s use of alcohol and drugs, and the lack of personal care. The employee may also be exposed to bodily fluids (blood, urine) and hazardous chemicals.
WellSpace Health is committed to the principals of equal employment. We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations. It is the intent of WellSpace Health to maintain a work environment free of harassment, discrimination, or retaliation because of age, race, religious creed, color, national origin, ancestry, physical disability, medical condition, genetic information, marital status, sex (including pregnancy, childbirth, breastfeeding and/or related medical conditions), gender, gender identity, gender expression, sexual orientation, military or veteran status, or any other status protected by federal, state or local laws. WellSpace Health is dedicated to the fulfillment of this policy in regard to all aspects of employment, including but not limited to recruiting, hiring, placement transfer, training, promotion, rates of pay, and other compensation, termination, and all other terms, conditions, and privileges of employment.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
WellSpace Health is an Equal Opportunity Employer
Company DescriptionWellSpace Health has provided care and support to individuals and families throughout the Sacramento region since 1953. Our focus has always been to offer a full range of quality medical care, dental care for children and adolescents, mental health and behavioral health services to underserved populations. We do this by placing ourselves within the communities we serve and employing outstanding healthcare professionals who are devoted to our mission.
WellSpace Health is a statewide leader in designing and delivering integrated care that treats the whole person, body and mind. Our people-first approach to comprehensive healthcare means that patients are embraced by a “blanket of care” delivered with competence and compassion.
Company Description
WellSpace Health has provided care and support to individuals and families throughout the Sacramento region since 1953. Our focus has always been to offer a full range of quality medical care, dental care for children and adolescents, mental health and behavioral health services to underserved populations. We do this by placing ourselves within the communities we serve and employing outstanding healthcare professionals who are devoted to our mission.\r\n\r\nWellSpace Health is a statewide leader in designing and delivering integrated care that treats the whole person, body and mind. Our people-first approach to comprehensive healthcare means that patients are embraced by a “blanket of care” delivered with competence and compassion.