Medical Access Specialist

Berkshire Hathaway Homestate Companies, Workers Compensation Division, has an immediate opening for a Medical Access Specialist. This critical support position will assist our Claims Adjusting teams in facilitating quality care for injured workers and advance claims outcomes by improving timely access to high-quality practitioners for appropriate medical care. Providing top-notch, timely care for injured workers in an effort to return them to pre-injury condition is a core objective of our company. This individual will work in close coordination with our Claims Professionals and the Networks and Panels teams to achieve optimal outcomes.

ESSENTIAL RESPONSIBILITIES

• Facilitate recovering worker care transitions to appropriate, high-quality medical providers.
• Research providers within, and if needed, outside the MPN to identify appropriate potential providers for our recovering workers.
• Utilize data analytic tools to identify high-quality providers.
• Facilitate appointments for recovering workers from initial care requests to complex specialist appointments
• Maintain log of referral activity, questions, and answers.
• Encourage Claims personnel to seek medical access support by communicating when and how to submit referrals and managing expectations throughout the process.
• Determine current challenges with existing medical access and propose solutions.
• Research and identify providers to direct care to in areas of limited availability or acceptance of workers’ compensation insurance.
• Serve as liaison between internal departments, external clients, vendors, and providers.
• Build and foster positive relationships with providers and vendors to work together to deliver timely and appropriate care.
• Utilize our provider contacts and identify additional contacts.
• Gather and report on information regarding providers (e.g., practitioners looking to expand their practice, those who will be scaling back or closing, those not accepting work comp patients, etc.).

REQUIRED QUALIFICATIONS

• Education: Bachelor of Science or Associates degree in a science or medical field from an accredited college or technical school required.
• Experience: Minimum of two years of experience in medical networks and panels, claims adjusting, medical services in workers compensation, or a related field required. Experience researching and applying statutes and regulations, preferably pertaining to workers compensation, highly preferred.

REQUIRED SKILLS

• Knowledge of current evidence-based treatment guidelines and clinic, hospital, or medical office operations.
• Ability to read, analyze, and interpret medical statutes, regulations, medical reports, medical coding, medical bills; ability to respond to technical inquiries from Company employees, external sources, and regulatory and auditing entities.
• Ability to effectively use Microsoft Office software and be able to master and become proficient proprietary and vended software programs.
• Excellent communicator with strong interpersonal and conflict resolution skills. Ability to successfully build relationships and adapt communication style in various environments. Listens and requests clarification. Responds well to questions and feedback. Contributes proactively in meetings. Speaks clearly and persuasively in a manner suitable to the understanding of the listener.
• Ability to think critically and adapt quickly in a flexible and dynamic environment. Ability to be proactive and inquisitive in approach to work. Ability to derive appropriate conclusions from various sources and research and apply on the job. Gathers and analyzes information skillfully and provides solutions in complex situations. Identifies items requiring additional information or action.

WHAT WE OFFER

• Work-Life Balance
• Modernized Historical Setting in East Sacramento
• Free Lot Parking

BENEFITS

• Paid Time Off
• Paid Holidays
• Retirements Savings Match
• Group Health Insurance (Medical, Dental, and Vision)
• Life and AD&D Insurance
• Long Term Disability Insurance
• Accident and Critical Illness Insurance
• Flexible Savings Accounts
• Paid Community Volunteer Day
• Employee Assistance Program
• Tuition Reimbursement Program
• Employee Referral Program
• Diversity, Equity and Inclusion Program

ABOUT US
With more than 50 years in business, BHHC has grown from a regional organization to a national insurance group, offering insurance products from coast to coast. Relationships are the cornerstone of our culture, and we believe in doing the right thing. That means we invest in our business in every way possible to deliver on our missio