Job Details

11422

Introduction
Visium Resources has been asked to identify qualified candidates for this Enrollment Ancillary Coordinator position. This position is a contract opportunity which is expected to be Remote for a duration of 3 Months with a possible extension.

The Enrollment Ancillary Coordinator is responsible for physician systems including applications and credentialing for various physician groups and specialties for which contracting services are provided.

• Maintains and updates all credentialing systems with current information for all physicians/providers.
• Responsible for coordinating and maintaining all credentialing documents necessary to complete credentialing and re-credentialing of all physicians/providers for which we contract.
• Responsible for auditing and data analysis for all physician/provider credentialing records, documents, and files.
• Responsible for programming Network Management applications to generate reports necessary to ensure accuracy of physician/provider records.
• Actively participates in physician group leadership meetings and is accountable for presenting credentialing status for all groups.
• Provides continuous training, coaching, and mentoring to the Enrollment Specialists and Ancillary Coordinator.
• Serves as a resource to other Enrollment Specialists/Coordinator and works alongside Credentialing Manager and Director of Credentialing and Revenue Management to develop and implement new policies/procedures/standards.
• Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

Essential Function: Physician Groups and Systems

• Responsible for the credentialing efforts for primary care and/or specialist physician and/or mid-level providers employed by the Hospitals Division physician groups.
• Assigns new providers to another Enrollment Specialists/Coordinator depending upon workload.
• Ensure credentialing information is complete based on the requirements of the specific provider type.
• Responsible for understanding and utilizing the functionality of Network Management (or any subsequent credentialing database) and training new employees.
• Responsible for programming physician/provider applications within Network Management (or any subsequent credentialing database) and works to ensure physician/provider information is complete, accurate, and up to date.
• Ensure that credentialing applications are scanned and programmed to populate physician information.
• Assists in maintaining a complete database (including CAQH) of all credentialing materials for all employed physicians/providers.
• Utilizes advanced level of skill relating to the understanding of payer credentialing nuances and disseminates such information and trains team members as necessary.
• Tracks re-credentialing and vendor roster requests coming into the department.

Communication:

• Communicate with physician/provider office staff and practice management regarding the status of applications, additional materials required, etc.
• Educates physician/provider and physician/provider leadership staff on necessary documentation needed to credential physician/provider.
• Responsible for ensuring that all documents are up to date and new documents are requested from Practice Management for any that may be expiring.
• Effectively communicates and is accountable to staff, leadership, payors, providers, patients, and visitors.
• Works with internal and external partners to resolve issues concerning credentialing loads.
• Researches and resolves routine provider operational issues with internal and external partners.
• Effectively participates and plays an integral role in meetings and discussions with regional leadership to include Managed Care Directors, Physician Group Leadership, and staff regarding internal issues, physician onboarding issues and payer issues.
• Deals with patient information in a sensitive manner to ensure respect and privacy for patient and expeditious handling of related issues.

Support:

• Supports the Credentialing Manager and Director of Credentialing, Contracting and Revenue Management by resolving problems, questions, and issues internally, as well as at the payer and the practice.
• Supports physician contracting and operation services by auditing and analyzing data, verifying applications, preparing amendment letters, ensuring physician/provider credentialing materials are processed efficiently, professionally, and as expeditious as possible.
• Researches any inconsistencies or discrepancies assigned by leadership and educates the entire team of findings.
• Supports the Negotiators through notification of current application status and new contract requirements.
• Assists and guides physicians/providers in determining information necessary for applications.
• Supports the overall mission of the Hospital and the role of the Managed Care department in that mission.
• Demonstrates an eagerness to assist co-workers in the completion of tasks as needed.
• Performs special projects and tasks as requested by senior staff and leadership.
   Supports the contracting team, internal departments, ancillaries, and physician groups, and owned PHOs as applicable, to assist with, identify, and resolve operational, accounts receivable, utilization management, quality assurance, billing, and other related issues.

Liaison & Information:

• Provides direction to staff members and serves as liaison to credentialing staff at both payor organizations and physician offices.
• Acts as provider relations' representative to physician groups to assist with operation and payment issues, as appropriate.
• Prints applications upon request and compiles specific information for re-credentialing
• Responsible for ensuring credentialing information is accurate and current in multiple venues such as hospital systems, local databases such as Network Management and Microsoft Access, files, and on-line databases such as CAQH.
• Coordinates process with Negotiators to ensure contracts are in place prior to sending applications to payer.
• Represents the Credentialing Manager and/or Director of Credentialing and Revenue Management in meetings when assigned to do so.

Development, Education and Training:

• Displays a willingness to grow and develop skills required to perform his/her job duties and assist with the training and education of team members.
• Takes the initiative to seek out education and training experience to grow and develop skills necessary to perform Enrollment Ancillary Coordinator duties and to stay informed of changes in the field of managed care and objectives of the department.
• As Enrollment Ancillary Coordinator this position is expected to help develop, train, and educate new and existing staff members. Reports results back to Manager/Director.
• Ability to assess individual credentialing staff member performance and communicates with leadership on needed areas of improvement.
• Assist leadership in ensuring all applicable internal policies, procedures and guidelines are adhered to by all team members.
• Supports manager with boarding and training of new coordinators
• Maintains step by step guide for manual and Job Aids
• Performs special projects as assigned or directed

Deadlines, Timeliness and Performance Standards:

• Completes assigned tasks in the appropriate time frame and maintains an acceptable work pace.
• In group situations, effectively contributes to the overall completion of work product according to the applicable directive and deadline.
• Does not interfere with the ability of co-workers to complete their duties.
• Readily able to adapt to new situations and changing priorities to accomplish department goals.
• Adheres to applicable internal policies, procedures, and guidelines set forth by Hospitals Health Systems, its associated hospitals, physician groups, PHOs, and ancillaries during the execution of assigned duties. 
• Abides by all applicable rules, regulations, and laws prescribed by any authoritative governing body such as the State of Florida, AHCA, etc.

Required:

• 4+ years of experience in healthcare; preferably in managed care, provider credentialing, patient financial services or provider relations
• Enrollment experience within a facility, urgent care or hospital.
• Must have CMS, MD Staff, Adobe Pro and Microsoft Office Suite
• Performs other duties as assigned
• Complies with all policies and standards

 Education Required:

• High School Diploma or equivalent
   

Preferred:

• Bachelor's in business, healthcare administration or related field
• 4+ years in healthcare or managed care
• PCAnywhere
• Network Management
• CAQH
• MSOW/Network Management