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Provider Program Specialist - Healthcare Services

Requisition Number:  40443
Location: 

Trevose, PA, US

International SOS is the world’s leading medical and security services company with over 12,000 employees working in 1,000 locations in 90 countries. We were founded on the principle of putting our clients’ employees first and this is still true today. Led by 5,200 medical professionals and 200 security specialists our teams work night and day to find solutions to protect our clients and their employees in whatever situation they may be facing; we assess, advise and assist from a medical, security and logistical perspective on a global scale to protect and save lives and thereby enable our clients to achieve their business goals. As we’ve delivered on this mission over the last 35 years, we have become the market leader in global telehealth services and digital health solutions for an extensive client base of Fortune 500 companies, NGO’s and governments around the world.

Essential Job Duties and Responsibilities:

 

Job Summary:

 

Medical, Security, Aviation and Logistic providers (the “network”) are a core Group asset and an essential part of our value proposition, supporting many products and services across all business lines within Intl.SOS.

Network Services is responsible for coordinating and overseeing the development, management and maintenance of the network in their allocated territory ensuring the highest level of quality, partnership and cost containment is achieved for Intl. SOS clients and business units, and to support Business development.

The Network Services Program Specialist is responsible for the implementation and the maintenance of Clients’ specific networks in the remit, based on specific requirements and in accordance with the Group directions.  This includes defining the scope and the cost, timelines, deliverables, to successfully conduct the Network Services delivery process till the recharge to the requestor.

Key Responsibilities:

 

Network Maintenance
  
•    Ensure that the provider and location data base (SPIN) is kept up to date, in compliance to Group Network Services Procedures under the supervision of the Local Network Services Manager and as per departmental yearly goals.
•    Maintain Country Specific Credentialing rules and perform due diligence credentialing checks on providers and oversee compliance with certification and requirements. 
•    Validation of network capabilities and level of care through desktop provider and location assessments.   
•    Delivering on the objectives and targets set in the Region’s Network Development Plan.
•    Escalate non-compliance to direct local Network Services Manager.
•    Maintain provider files and SPIN entries to Intl. SOS standards.
•    Owner of the SPIN Customer / Program for the clients’ specific networks in the remit, ensuring the compliance to SPIN quality standards for providers designated, developing provider reporting matrix - quality metrics, utilization, level of credentialing, for the monitoring

 

Program Delivery

 

•    In accordance with the agreed scope (as defined in a client’s proposal), coordinate responses to clients’ specific requests in the remit.
•    Document and provide to Network Services teams the set of qualifying criteria with inputs from Group/Regional Network Services or any other relevant functions.
•    Provide guidance to the Network Services teams responsible for managing and sourcing the client’s specific network based on the designated criteria, the Group network services standards and procedures, and quality of care considerations.
•    Working closely with local Network Services teams, support the development and implementation of project plans, for new and existing client’s provider network needs to ensure client’s specific requirements are met.
•    Ensure the network services deliverable to Consulting (or the client) is produced on time and to quality in line with the agreed expectations set when the scope was agreed.

 

Key Responsibilities (cont.):

 

Relationship Management 

 

•    Maintaining direct longstanding relationships with providers to ensure good collaboration and outcomes.
•    Conduct provider education on client program benefits prior to provider network inclusion, as well as supporting on-going provider education initiatives.  
•    Support in formalising written agreements with providers.
•    Ensure that all providers in the clients’ specific networks are well educated to deliver excellent service to the clients through regular communication.
•    Support in the investigation of provider quality incidents - engaging with all the relevant stakeholders - reporting back to the Local Network Services Manager and Quality Manager and taking the necessary corrective actions.
•    Deal positively with internal/external complaints, including those from providers and members. These are to be resolved wherever possible in a timely manner, or referring them to the appropriate department/GAN/Management for direction
•    Always maintain a courteous and professional manner when dealing with service providers, customers and colleagues. 
•    Supporting the Local Network Service Manager in filling network gaps identified.
•    Establish responsive liaison arrangements both within International SOS and externally.
•    Positively promote International SOS to other organizations and providers.
•    Ensure that local Network Services time and efforts in support of the Clients specific network requirements are optimized and recognized.
 

Finance Support
 
•    Working with Finance teams to ensure providers are paid in a timely manner and finance KPIs are met.
•    Follow up and resolve provider payment queries and follow up on ageing GOPs with providers.

Business Support 

•    Supporting MSAS in active case management requiring network support.
•    Supporting in the delivery of Consulting solutions.
•    Supporting the development and maintenance of program specific networks in the allocated territory (Health Check Programs AVMAR, TRICARE, IHMS, Client bespoke networks). 
•    Educate internal staff in the effective use of the provider network and SPIN. 
•    Support the development and maintenance of SPIN system through User Acceptance testing.
•    Be accountable to the Managers regarding workload and movements.
•    Maintain all client information which may be encountered either directly or indirectly while in the performance of the job in strict confidentiality in accordance with HIPAA and/or any other pertinent confidentiality regulations.

 

Other Duties 

 

•    To attend supervision, training, meetings as and when required. There may be a necessity for these to be outside normal working times.
•    To work within and promote all International SOS policies and procedures.

 

Job Profile:

 

Required Skills, Knowledge & Competencies

 

•    Ability to prioritize.
•    Ability to communicate effectively and build relationships with internal and external stakeholders.
•    Demonstrate appropriate listening skills.
•    Demonstrate proper spelling and grammar skills.
•    Team player but able to work independently as well. 
•    Ability to effectively manage competing priorities across multiple projects and business lines.
•    Good administrative, customer service management skills.
•    Ability to negotiate. 
•    Ability to identify and acts on potential problems.
•    Strong attention to detail and quality. 
•    Ability to perform well with minimal supervision.
•    Ability to provide clear and concise written updates.
•    Proficiency in Microsoft suite (MS Word, Excel, PowerPoint, Outlook, Teams). 

 

Required Work Experience 

 

•    2 to 5 years working experience in Medical / Healthcare or Services industry desirable.  
•    Good commercial acumen and negotiation experience required 
•    Business analyst exposure a strong advantage.
•    Working experience cross cultures would be an advantage
•    Experience within an operational and / or procedural driven environment.
•    Experience within the considered geographical territory of the USA, Canada & Latin America (desirable).

 

Required Qualifications 

 

•    Bachelor’s Degree 
•    Experience in Medical, Healthcare Management or Customer Service Industry desirable.

 

Behaviors

 

•    Alignment with the Intl. SOS values of Passion, Expertise, Respect and Care.

 

Required Languages 

 

•    Excellent written and spoken skills in the English language.  
•    Fluency or proficiency in a second language preferred (Spanish or Portuguese).

 

Job conditions

 

•    Minimal travel required. Short business trips subject to planned and immediate needs and therefore travel activities may differ from period to period.

International SOS is an equal opportunity employer and does not discriminate against employees or job applicants on the basis of race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, amnesty or status as a covered veteran in accordance with applicable federal, state and local laws.