JOB SUMMARY:
Provides support to business by coordinating care to workers compensation patients via the telephone and/or Internet (e.g., instant message, email). Handles inquiries and resolves simple and basic issues, scheduling appointments, or managing visits; and responsible for ensuring treatment is appropriately planned and managed from initial treatment visit to treatment completion, and all customers are continuously updated and satisfied. Coordinates the dental treatment of assigned case files. For product or service-related issues, will move patient to appropriate department. Performs other administrative duties as requested.
ESSENTIAL DUTIES & RESPONSIBILITIES:
Customer Support: 80%
- Serves as primary contact for coordination of care and patient issues. Escalates more technical or medical-related issues to the proper department.
- Coordinates internal and external resources in order to ensure files move forward within established timeframes.
- Prioritizes daily activities in a manner that all assignments are completed. Reviews and responds to any requests from clients, provider, claimant, or supervisor and performs necessary action steps within 48 hrs.
- May take referrals from adjusters, case managers and sales representatives and forward to appropriate department for processing. *Care coordinators do not process referrals - managed by the Intake department.
- May process and resolve a high volume of patient inquiries about One Call products and services.
- Utilizes appropriate tracking tools, i.e., authorization logs, Outlook Calendar or Portal Task function, to ensure follow-up on critical timelines as outlined in One Call’s Dental department’s procedures for obtaining evaluations/notes, tracking authorizations, and contacting carriers.
- Tracks and documents inbound support requests and ensures proper notation of problems or issues.
- Enters new plans of treatment, requesting pricing and clinical review.
- Negotiates rates of reimbursement, as applicable. Coordinates any special payment arrangements for non-contracted providers.
Critical Thinking: 10%
- Troubleshoots patient problems; identifies the root cause of the problem; and uses tool and resources appropriately to determine how to resolve problems. Contacts dental provider or adjuster to obtain authorization for additional or continued service(s).
- When unable to resolve the problem in a reasonable amount of time, will escalate to the appropriate resource. Follows up on escalated issues with coaching and mentoring to learn the appropriate solution and expand overall knowledge.
- Engages in process improvement strategies by providing constructive feedback on processes, tools and resources.
- May be required to test new Information Technology applications and/or functionality for technical enhancements to the Dental platform.
Administrative: 10%
- Requests all missing documentation such as notes, claims, state forms, authorizations and images for each appointment as necessary.
- Review all incoming documents for accuracy and legibility. Sends all supporting documentation and state forms to the customer.
- Accurately estimates treatment dates by line item based on the approved treatment plan, required healing time and all coordination between services to ensure accurate revenue forecasting.
EDUCATIONAL AND EXPERIENCE REQUIREMENTS:
- High school diploma/GED required.
- Certified Dental Assistant - highly preferred.
- Expanded Functions preferred, or the equivalent combination of education, training, and work experience.
ESSENTIAL KNOWLEDGE, SKILLS & ABILITIES:
- Excellent verbal and written communication skills.
- Excellent interpersonal and customer service skills.
- Excellent organizational skills and attention to detail.
- Excellent time management skills with a proven ability to meet deadlines.
- Strong analytical and problem-solving skills.
- Ability to function well in a high-paced and at times stressful environment.
- Proficient with Microsoft Office. To perform this job successfully, an individual should have intermediate skills in Microsoft Outlook; Microsoft Word; Microsoft Excel; Internet Explorer; internet software and database software.
- Ability to work in an environment that aligns with the company's diversity, equity, inclusion and belonging standards.
- Ability to work both independently and in a team environment.
- 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 in a stationary position for extended periods of time, 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 have a speed or productivity requirement.
- The colleague must be able to manage moderate to significant mental stress as a result 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.
Dental Care Coordinator Senior
Senior level role. Highly-skilled with extensive proficiency. Responds to a high volume of inquiries about One Call Care Management’s products and services. Questions and issues are predominantly routine but associate must be able to deviate from standard scripts and procedures as needed. Handles situations which may require adaptation of response or extensive research. May require advanced problem solving. Plays a lead role in escalations. Coaches and shares information with professionals with less experience and/or expertise. Works under general supervision with some latitude for independent judgment and has the ability to organize workload to accomplish goals. Typically requires four or more years of experience in a call center or customer service-related position in a service industry. Internal Advancement: One or more years as Care Coordinator II; External Candidates: 3+ years in Workers’ Compensation services experience is required. Care Coordinator Seniors are expected to meet established quality metrics and exceed established productivity metrics. In addition to being cross-trained to perform other Dental tasks, will have the ability to handle multiple tasks and functions within the Dental department.
