JOB SUMMARY:
The Negotiations Specialist will provide real-time support to Operations by locating out-of-network providers and/or addressing in-network providers requesting rates outside of their contract by negotiating single rate agreements or identifying in-network providers willing to accept the referral utilizing contracted rates. The Negotiations Specialist is a partner to the scheduling team, ensuring that One Call secures providers and confirms negotiated services are started timely.
ESSENTIAL DUTIES & RESPONSIBILITIES:
Negotiation: 40%
Conduct negotiations with out-of-network/network providers for prospective referrals utilizing established guidelines.
Executes short-term agreements (i.e., Single Referral Agreements) for One Call’s referrals if we are unable to staff through One Call’s provider network.
Works with contracted providers that request reimbursement outside of contracted rates in conjunction with the Provider Engagement & Contracting Teams.
Recruiting Providers: 30%
Effectively and timely locate an out-of-network provider that meets the operational needs of a specific referral.
Effectively communicate the One Call value proposition to out-of-network providers.
Submit interested or viable non-contracted providers to Provider Contracting for contracting opportunities.
Compliance: 15%
Acquires minimum provider qualification documents at completion of Single Referral Agreement.
Submits Single Referral Agreement request to Provider Data Management.
Ensures proper notation and documentation for each assigned task is clean, clear, and concise.
Customer Care: 15%
Cleary communicates dates and other instructions with the service provider(s) for negotiated files.
Confirms Start of Care for negotiated files.
Meets the established team standards, including (but not limited to) quality standards and turnaround time requirements.
Provides an outstanding experience to internal and external customers, where applicable.
Able to support various levels of management on ad-hoc requests and perform other related duties as assigned.
EDUCATIONAL AND EXPERIENCE REQUIREMENTS:
Associate’s degree, or 1-2 years experience instead of a degree.
ESSENTIAL KNOWLEDGE, SKILLS & ABILITIES:
Financial acumen.
Proficient in negotiating with the ability to calculate margins based on client & provider pricing.
Good understanding of One Call products and services.
General knowledge of the workers’ compensation industry.
General knowledge of negotiation principles.
Excellent customer service competencies.
Excellent verbal and written communication skills.
Proficiency to operate independently on work that is often confidential.
Computer navigation and operation skills.
Demonstrates effective people skills and sensitivities when dealing with others.
Able to work both independently and in a team environment.
Communicates concisely, and professionally.
Able to understand, apply, and explain concepts.
Able to handle projects commensurate with job expectations.
Able to analyze and solve problems using learned techniques and tools.
Requires human relations, negotiation, and documentation skills.
Requires high attention to detail.
Flexibility, versatility, and dependability.
Able to work in an environment that aligns with the company's diversity, equity, inclusion, and belonging standards.
Able to work both independently and in a team
Demonstrate our core values of Think Big, Go Fast, Deliver Awe, and Win Together.
PHYSICAL/MENTAL DEMANDS & WORK ENVIRONMENT:
This position will be performed in the colleague’s home. Work-from-home requirements include the colleague’s ability to set up computer equipment within their home office.
This job is primarily sedentary and may involve repetitive motions; the colleague must be able to remain stationary for extended periods, operate a computer and other office equipment, assess information and files stored electronically, and converse/exchange accurate information with others, simultaneously.
The colleague must be able to discern text displayed on a monitor, input data into specific fields using a keyboard, and adjust focus to distances of up to three feet.
The colleague must have the ability to learn new tasks, follow established processes, maintain focus, complete tasks independently, complete multiple tasks simultaneously, communicate professionally with colleagues and customers, and complete tasks in situations that require speed or productivity.
The colleague must be able to manage moderate to significant mental stress because of, but not limited to, a dynamic and heavy workload.
Please be advised that job descriptions typically change over time as business needs, job requirements, and employee skill levels change. As such, One Call retains the right to change or assign other duties to this position at any time.
ADDITIONAL LEVELS WITHIN JOB FAMILY:
Negotiation Specialist I
The Negotiation Specialist I has a general understanding of staffing, healthcare products, and services, and the ability to negotiate single referral agreement pricing. Works under close supervision with limited latitude for independent judgment. Consults with senior peers as necessary for non-standard issues and unconventional challenges.
The Negotiations Specialist will provide real-time support to Operations by locating out-of-network providers and/or addressing in-network providers requesting rates outside of their contract by negotiating single rate agreements or identifying in-network providers willing to accept the referral utilizing contracted rates. The Negotiations Specialist is a partner to the scheduling team, ensuring that One Call secures providers and confirms negotiated services are started timely.
ESSENTIAL DUTIES & RESPONSIBILITIES:
Negotiation: 40%
Conduct negotiations with out-of-network/network providers for prospective referrals utilizing established guidelines.
Executes short-term agreements (i.e., Single Referral Agreements) for One Call’s referrals if we are unable to staff through One Call’s provider network.
Works with contracted providers that request reimbursement outside of contracted rates in conjunction with the Provider Engagement & Contracting Teams.
Recruiting Providers: 30%
Effectively and timely locate an out-of-network provider that meets the operational needs of a specific referral.
Effectively communicate the One Call value proposition to out-of-network providers.
Submit interested or viable non-contracted providers to Provider Contracting for contracting opportunities.
Compliance: 15%
Acquires minimum provider qualification documents at completion of Single Referral Agreement.
Submits Single Referral Agreement request to Provider Data Management.
Ensures proper notation and documentation for each assigned task is clean, clear, and concise.
Customer Care: 15%
Cleary communicates dates and other instructions with the service provider(s) for negotiated files.
Confirms Start of Care for negotiated files.
Meets the established team standards, including (but not limited to) quality standards and turnaround time requirements.
Provides an outstanding experience to internal and external customers, where applicable.
Able to support various levels of management on ad-hoc requests and perform other related duties as assigned.
EDUCATIONAL AND EXPERIENCE REQUIREMENTS:
Associate’s degree, or 1-2 years experience instead of a degree.
ESSENTIAL KNOWLEDGE, SKILLS & ABILITIES:
Financial acumen.
Proficient in negotiating with the ability to calculate margins based on client & provider pricing.
Good understanding of One Call products and services.
General knowledge of the workers’ compensation industry.
General knowledge of negotiation principles.
Excellent customer service competencies.
Excellent verbal and written communication skills.
Proficiency to operate independently on work that is often confidential.
Computer navigation and operation skills.
Demonstrates effective people skills and sensitivities when dealing with others.
Able to work both independently and in a team environment.
Communicates concisely, and professionally.
Able to understand, apply, and explain concepts.
Able to handle projects commensurate with job expectations.
Able to analyze and solve problems using learned techniques and tools.
Requires human relations, negotiation, and documentation skills.
Requires high attention to detail.
Flexibility, versatility, and dependability.
Able to work in an environment that aligns with the company's diversity, equity, inclusion, and belonging standards.
Able to work both independently and in a team
Demonstrate our core values of Think Big, Go Fast, Deliver Awe, and Win Together.
PHYSICAL/MENTAL DEMANDS & WORK ENVIRONMENT:
This position will be performed in the colleague’s home. Work-from-home requirements include the colleague’s ability to set up computer equipment within their home office.
This job is primarily sedentary and may involve repetitive motions; the colleague must be able to remain stationary for extended periods, operate a computer and other office equipment, assess information and files stored electronically, and converse/exchange accurate information with others, simultaneously.
The colleague must be able to discern text displayed on a monitor, input data into specific fields using a keyboard, and adjust focus to distances of up to three feet.
The colleague must have the ability to learn new tasks, follow established processes, maintain focus, complete tasks independently, complete multiple tasks simultaneously, communicate professionally with colleagues and customers, and complete tasks in situations that require speed or productivity.
The colleague must be able to manage moderate to significant mental stress because of, but not limited to, a dynamic and heavy workload.
Please be advised that job descriptions typically change over time as business needs, job requirements, and employee skill levels change. As such, One Call retains the right to change or assign other duties to this position at any time.
ADDITIONAL LEVELS WITHIN JOB FAMILY:
Negotiation Specialist I
The Negotiation Specialist I has a general understanding of staffing, healthcare products, and services, and the ability to negotiate single referral agreement pricing. Works under close supervision with limited latitude for independent judgment. Consults with senior peers as necessary for non-standard issues and unconventional challenges.