Texarkana, Texas
Chula Vista, California
Chicago, Illinois
Posted: 09-Aug-24
Location: Texarkana, Texas
Salary: Open
Categories:
Internal Number: 213613
Summary:
Responsible for the administration and operational activities associated with day-to-day PHO function including healthcare contracting and provider relations ? both financially and operationally ? payor relations, network development and other related duties for contracted health plans independently and under direction from the Executive Director. Maintains and continues development of centralized facility credentialing to CHRISTUS Health System Managed Care Department. Position will include provider education, database development and administration, marketing and promotion and assistance with provider credentialing and certification as needed.
Responsibilities:
- Leads Network growth through provider education, selling of services and office orientations through on-site meetings and a variety of communications
- Leads network development through contract rate negotiation and processing
- Serves as provider liaison point person for all Network issues whether on provider/physician or client company side
- Provides excellent, timely customer service with focus on retention of providers, clients, brokers, consultants, TPAs, etc., to ensure Network satisfaction and usage
- Assists with Board of Director meetings, Credentialing Committee meetings and all other Network sales meetings as needed
- Assists with credentialing and recredentialing process
- Other duties as assigned
- Complete understanding of PHO contracts and reimbursement methodologies in all areas to provide support to physicians and health care provider office staff.
- Complete understanding of various managed care contracts included, but not limited to, type of plan, network, contracted reimbursement, claims issues, and physician loading procedures.
- Update provider offices of new contracts and changes in contracts. Updates contracted health plans and select payors on changes in key provider information to ensure accurate records and claims payment.
- Assists with the update of payor network rosters, directors, and matrices as required to maintain accurate participation records. Verifies and requests written notification when requested by health plans or payors.
- Maintains a positive attitude and working relationship with PHO physicians and contracted payors to resolve operational problems and concerns.
- Schedules and coordinates committee and board meetings as requested.
- Documents committee meetings with detailed minutes and produces final minutes in a timely manner as requested.
- Conducts provider education in accordance with the relevant requirements of each plan, as assigned, to include development of provider manuals and newsletters and development, assessment and delivery of proper training.
- Schedules and facilitates regular meetings of the Office Advisory Committee consisting of key physician office staff in order to provide an open forum for discussion on contracts, claims issues, current news and updates.
- Prepare quarterly accounting invoices, daily bank deposits, keep accurate accounting records, and other accounting duties as necessary.
- Assists in the overall administrative effort of the PHO office as requested.
- Works closely with PHO staff.
Requirements:
Education/Skills
- Bachelor's Degree preferred
- Excellent computer skills and typing ability.
- Must possess excellent organizational, interpersonal, and verbal/written communication skills.
- Ability to work with minimal supervision.
Experience
- Two to five years clerical experience, preferably in hospital setting or an equivalent
Licenses, Registrations, or Certifications
- None required
Work Type:
Full Time
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