Aultman Health Foundation Job - 40087108 | CareerArc
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Company: Aultman Health Foundation
Location: Canton, OH
Career Level: Entry Level
Industries: Healthcare, Pharmaceutical, Biotech

Description

PURPOSE OF POSITION:

The primary purpose of the Employer Liaison is to assure that a customer service-focused partnership is maintained with AultComp MCO's employer client base.  The Employer Liaison reviews, examines, investigates, and analyzes claims/report data and provides information and assistance with matters that impact the employer.

The Employer Liaison will accomplish this goal by utilizing available resources, knowledge and manages time effectively to accomplish critical tasks/projects. 

 

RESPONSIBILITIES & EXPECTATIONS:

  • Functions as the main contact for assigned employers
    • Required to assist with additional employers as needed.
  • Assist with timely problem solving/resolution for any identified claims.
  • Effectively facilitate resolution of issues that require multiple departments.
  • Provide onsite provider and/or employer visits when necessary to ensure RTW goals are met.
  • Regularly update the claims management system with any claim and/or employer updates/notes.  
  • Use sound judgment and policy provision interpretation to manage claim outcomes.
  • Apply BWC rules and standards for appropriate care coordination outcomes and employer satisfaction.
  • Function as account liaison between MCO and the employer Third Party Administrator or legal representatives.
  • Establish and maintain a routine contact with assigned employers.
  • Establish and maintain a routine site visit schedule based on employee population and needs.
  • Responsible to update the internal claims management system based on the 816 transaction from the BWC.
  • Assists/Coordinates the development and distribution of employer reports.
  • Assists sales and corporate marketing staff with website design needs.
  • Responsible to forward welcome packets to all new MCO accounts within 30 days of receipt of notification of a new client. 
  • Coordinates individual client education as requested by the employer.
  • Partner with medical management staff, providers and the employer for ongoing return to work management.
  • Be a resource to the employers, medical management and billing staff.
  • Provide ongoing educational opportunities as it relates to claims.
  • Assist the sales staff and broker community during Open Enrollment and on an as needed basis.
     
  • Attend BWC meetings and educational sessions as directed by BWC and/or MCO Manager.
  • May be involved in various aspects of the day to day organization processes
  • Attend various networking events to be “a face” for the MCO.
  • Contributes to achievement of organization performance goals by acting in a support role to medical management staff and Manager.
  • Work with medical management staff to assure policy compliance with the HPP, coordinating ongoing policy review, revision and development to assure compliance.
  • Assist management to assure MCO compliance with MCO/BWC contract stipulations and accreditation marketing standards.
  • Coordinates MCO project work as directed by management.
  • Assist management with provider network management.  Communicates changes, additions, deletions according to BWC policy.
  • Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.
  • Seeks supervisory guidance/approval as appropriate.
  • Portrays professional image: follows dress code, communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.
  • Promotes and demonstrates professional standards to enhance the development of the department.
  • Practices ethical conduct.
  • Meets acceptable attendance and punctuality expectations (excluding FMLA)
     
    The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and shall not be considered as a detailed description of all the work requirements that may be inherent to this position.
    All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, or protected veteran status.  AultCare is an EEO/AA Employer M/F/Disability/Vet.

 

  • AultCare/AHF will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on AultCare/AHF or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the AultCare Human Resource Department and request such an accommodation. 
     
     
    QUALIFICATIONS:
  • Education:  Associates Degree or three years of equivalent experience in Ohio Workers' Compensation managed care, third party and/or BWC experience.
  • Experience: Occupational medicine, claim management, workers' compensation desirable.
  • Organized self-starter with focused goals and deadlines.
     
    WORKING CONDITIONS:
  • Office environment with moderate noise level.
  • Frequent sitting, use of hands/fingers across keyboard or mouse, and long periods working at a computer.
  • Occasionally walking, standing, twisting/turning and reaching upward or forward during work day.


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