Responsible for obtaining necessary information and documentation to enable the submission of third-party payer applications and contracts. Performs the necessary follow-up to confirm physician provider numbers have been assigned by payers and are logged into the Morrisey credentialing system. Responsible for maintaining physician payer application records and training new staff on payer application process. Maintains good business relationships with payers to facilitate payer application process. The position serves as the coordinator for the payer application process for employed physicians and voluntary physicians as requested for all operating units and Care New England Medical Group.
Duties and Responsibilities:
1. Working in conjunction with the provider on-boarding team, responsible for coordinating, processing, and maintaining initial payer application information and documentation for new/established/voluntary and CNEMG practitioners utilizing the Morrissey credentialing system.
2. Process payer re-credentialing information as requested (initial applications are priority).
3. Maintain and update CAQH database as necessary for processing applications and recertification of provider as required.
4. Develop and maintain relationships with key contacts with payers and internal departments (especially Medical Staff office and clinical departments).
5. Monitor payers for updates/modifications to their credentialing process and documentation; communicate changes to appropriate staff.
6. Daily, documents and resolves issues in a timely manner, consistent with established department standards.
7. Participate in task forces and/or other meetings as assigned and execute other responsibilities (including administrative assistant duties) as assigned.
8. Performs other job-related duties as assigned or directed.
Requirements:
Associates degree preferred with one to three years of experience in secretarial functions, with at least one year of experience in dealing with physicians, hospitals and managed care organizations, or equivalent combination of education and experience. Must have exceptional interpersonal skills, telephone etiquette, and written communication skills. Computer experience with Microsoft office products including Word and Excel is required. Must have the ability to be persistent with application follow-up process, while maintaining positive working relationships with customers, clients, and co-workers. Ability to demonstrate a high level of organizational skills, specifically file maintenance and record keeping. Experience in physician payer credentialing, physician practice management, and physician billing procedures are preferred.
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