Health First

posted 2 months ago

Full-time
Ambulatory Health Care Services

About the position

The position serves as the primary point of contact for all delegated and non-delegated entities concerning the onboarding and credentialing of providers. The individual in this role is responsible for resolving all issues that arise, whether they are identified by the provider or internally, that may impact the physician's practice. This includes scheduling regular meetings with assigned delegated entities to identify and troubleshoot issues, as well as training and educating these entities on-site regarding the onboarding delegated process. Additionally, the role involves conducting investigations to ensure that the online Provider directory is consistently updated and accurate. The individual will be tasked with making necessary changes to maintain the directory's accuracy at all times. This includes configuring new provider loads, updates, and terminations, as well as providing assistance and guidance with large ad-hoc data entry projects within the Managed Health Services (MHS). The position also requires performing quarterly roster reconciliations to ensure that the health plan directory remains current, accurate, and compliant with department guidelines, regulations, and government laws. The individual will be designated to receive and review provider credentialing applications, coordinating with hospitals, clinics, medical staff, and practitioners to ensure that the privileging process is completed in a timely manner. This includes determining whether additional documentation, verifications, references, or applications are needed. Furthermore, the individual will receive, review, and submit provider contracts, coordinating with Network Management staff to finalize provider applications and contracts, and ensuring timely follow-up for approvals. Additional duties may be assigned as necessary.

Responsibilities

  • Act as the primary point of contact for onboarding and credentialing providers.
  • Resolve issues identified by providers and internally that impact physicians.
  • Schedule regular meetings with delegated entities to troubleshoot issues.
  • Train and educate entities on the onboarding delegated process.
  • Investigate to ensure the online Provider directory is accurate and updated.
  • Configure new provider loads, updates, and terminations.
  • Assist with large ad-hoc data entry projects in MHS.
  • Perform quarterly roster reconciliations to ensure directory compliance.
  • Receive and review provider credentialing applications.
  • Coordinate with hospitals, clinics, and practitioners for timely privileging processes.
  • Determine if additional documentation or verifications are needed.
  • Receive, review, and submit provider contracts.
  • Coordinate with Network Management staff to finalize applications and contracts.
  • Ensure timely follow-up for provider application approvals.
  • Perform additional duties as assigned.

Requirements

  • Associate's degree or relevant work experience.
  • Familiarity with Credentialing and Provider rosters.
  • Understanding of Network Management.
  • Experience working as a liaison with providers and internal support groups.
  • Experience meeting deadlines under time-sensitive constraints.
  • Experience adapting to last-minute project requests.
  • Ability to work independently with minimal supervision.
  • Effective communication skills with providers and internal staff.
  • Demonstrated flexibility and adaptability to changing priorities.
  • Strong time management skills with the ability to manage multiple tasks.
  • Computer proficiency (Excel, VLOOKUP, pivot tables, formulas, reporting).
  • Strong oral and written communication skills.
  • Critical thinking skills.

Nice-to-haves

  • Bachelor's Degree or above.
  • Experience with MHS, DocuSign, and CRM software.
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