Provider Network Specialist jobs in Richmond, VA

The Provider Network Quality Assurance Coordinator is responsible for supporting initiatives that promote the quality of CorVel’s Provider Network. This role is crucial in maintaining compliance and integrity of the network, which affects the care and satisfaction of patients and stakeholders within the organization.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

• Triage and Handling - Manage queue for incoming work, address and resolve any issues related to provider network quality promptly.
• Effectively communicate with network providers, CorVel staff and stakeholders to collect pertinent information for quality investigations.
• Maintain records and documentation related to provider network quality and compliance.
• Generate and send formal written notification of committee decisions and case resolutions.
• Prepare files and summarize any issues to be presented to the quality assurance committee.
• Provide guidance to network providers at the direction of the quality assurance committee.
• Ensure that providers adhere to relevant regulations and quality standards.
• Monitor patient feedback and address concerns related to network provider quality.
• Collaborate with various departments to optimize the provider network.
• Analyze data related to provider performance, patient outcomes and satisfaction.
• Research as needed and keep up to date with applicable regulatory standards, quality assurance program, and standard operating procedures.
• Comply with all safety rules and regulations during working hours in conjunction with the Injury and Illness Prevention Program (“IIPP”).
• Regular and consistent attendance.
• Additional projects and duties as assigned.

KNOWLEDGE & SKILLS:

• Excellent written and verbal communication skills.
• Ability to learn rapidly to develop knowledge and understanding of applicable regulatory standards.
• Ability to identify, analyze and solve problems.
• Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets.
• Strong interpersonal, time management and organizational skills.
• Ability to work both independently and within a team environment.

EDUCATION/EXPERIENCE:

• Highschool Diploma or equivalent
• Minimum of 2 years prior customer service experience within the insurance industry, managed care, or related field.

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range: $21.12 - $31.55 per hour

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

ABOUT CORVEL:

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.