This position interacts with and discusses contract and credentialing with physicians, specialist, ancillary providers and hospitals. Performs revenue analyses for the Provider Relation/ Network Department.
Essential Functions & Responsibilities
Target and/or follow-up with potential providers to establish contractual agreements.
Interacts with provides regarding all contract matters for HN1 including any necessary documentation. (i.e. credentialing, applications, W-9, PIP, etc)
Recruits and contracts physicians, specialists, ancillary providers and hospitals for HN1.
Responds to provider inquiries regarding contract matters, provider networks issues and HN1 operations.
Works with contracted providers to help integrate their services into the overall care delivery network.
Researches and solves any questions or concerns that providers, external provider representatives, Health Plans and other internal departments, may have
Analyzes, prepares, maintains and distributes various departmental reports, including specialized reports for providers or networks; HN1 quarterly provider bulletins; various presentations and custom reports requested by Senior Management.
Organize, develop and execute provider outreach projects.
Researches provider’s utilization data with reference to negotiating new rates and utilization performance of individual providers and the network.
Maintain lines of communications with all internal departments and with all participating providers in enlisting their assistance in referring potential providers in the Network.
Attend corporate and departmental meetings to assist with company projects and goals (i.e.
URAC, Executive Committee meetings, etc.)
Ensures compliance with and/or adheres to company HIPAA policies and procedures.
Ensures integrity of data entered into company systems and databases.
Manage the normal office activities for the Network Department to include but not limited to:
Maintains and updates physician files.
Composes and types routine correspondences
Reads and routes incoming mail and prepares outgoing mail and correspondences, including emails and faxes.
Answers and screens departmental telephone calls, and arranges conference calls.
Coordinates department’s schedule and schedules appointments
Arranges and coordinates travel schedules and reservations
Coordinates and arranges meetings, prepares agendas, reserves and prepares facilities, and records and transcribes minutes of meetings.
Other Responsibilities
Support other departments as needed.
Supports Credentialing Department by assisting with the collection of physician credentials for re-credentialing purposes.
Evaluates claim data on recently contracted providers, ensuring contract is profitable for Company.
Required Education and Experience
English/Spanish Required
High School graduate or equivalent (GED); and previous health care experience.