Acts as liaison with clinical departments to ensure optimal flow of information between the providers and MPBS.
Acts as a Liaison with the Managed Care Team for group and provider enrollment/maintenance for non-government payers.
Ensures appropriate and accurate maintenance of group enrollment records with Government Payers.
Ensures appropriate maintenance of a knowledge database of current enrollment guidelines and requirements.
Ensures that unfavorable payer decisions/enrollment records are corrected and/or appealed in a timely manner.
Maintains knowledge of contemporary standards and issues in provider enrollment, credentialing, managed care related, and NCQA trends.
Monitors Accounts Receivable and ensure its resolution when impacted by provider enrollment related occurrences/issues.
Participates in educational/professional development activities. Exemplifies Guest and Staff Relations standards in all activities in areas of service, resource utilization, high quality outcomes and effective communication and holds staff accountable for conformity with those standards in all activities.
Performs all activities related to successful enrollment and recertification of MPBS providers.
Reviews and analyzes billing dictionary records for accuracy.
Reviews and approves new enrollment records and ensures IDX dictionary updates and reviews and corrects provider related edits in IDX/ETM systems.
Reviews and responds to provider enrollment related questions/concerns and correspondence in a timely manner.
Reviews, identifies, corrects, and maintains provider enrollment paper/electronic records as well as provider profiles with payers.
Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.
Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings, serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.
Performs other duties as assigned.