Los Angeles, California
Little Rock, Arkansas
Coastal, Delaware
Posted: 31-Aug-24
Location: Greenwood Village, Colorado
Salary: Open
Categories:
Internal Number: 24030322
All the benefits and perks you need for you and your family:
- Benefits from Day One
- Paid Days Off from Day One
- Student Loan Repayment Program
- Career Development
- Whole Person Wellbeing Resources
Our promise to you:
Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind, and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Schedule: Full-time
Shift: Days
Location: Remote
The role you’ll contribute:
This position has dually aligned responsibilities, while striving for excellent quality of patient care; 1). Credentialing & On-Boarding: Manages an assigned territory as the key liaison, responsible to work with AdventHealth Physician Group’s Operations and Clinic Transitions teams to ensure a smooth on-boarding experience for our providers. Coordinates a comprehensive specialized credentialing program to assure compliance with the payer credentialing requirements and delegated carrier agreements and NCQA requirements that are built into our policies and procedures. Manages our NCQA certification, and annual delegated commercial payer audits assigned., and 2). Facility Credentialing & Privileging: Coordinates and completes all required medical staff and health professional applications, forms and delineation of privileging information for our medical staff partners.
The value you’ll bring to the team:
- Manage an assigned territory of providers, completing all commercial delegated credentialing requirements, collection of all government enrollment materials, to ensure meeting the targeted employment effective date; At-risk priority: on-going monitoring to meet effective dates, avoid claim revenue losses, referral/preauthorization’s, continual communication with operations, recruiting and new providers.
- Communicates with OMA leadership to escalate slow or non-responsive providers who are at risk of meeting their assigned employment effective dates.
- Coordinates and manages communications through SharePoint software with multiple on-boarding teams, validation of accurate information, tracking step-by-step progress on each assigned provider documented clearly; Accuracy of demographics drives our ability to collect on claims revenue, as well as reflect on AdventHealth’s website correctly for patient referrals.
- Must understand strategies of how clinics are set up, tax id#’s, group NPI#’s, to assist employed clinics as well as assist in developing opportunities for non-employed clinics (to collect on claims revenue).
The expertise and experiences you’ll need to succeed:
- Highschool Diploma/GED
- Two (2) years of healthcare-related physician/allied health professionals credentialing experience, medical staff related experience, or degree in business administration or medical staff services in management, in lieu of experience.
