Summary:

Responsible for the oversight of all contract files utilizing Tract Manager and other applicable resources. Establishes processes and maintains systems relating to the various contracting functions necessary to ensure the success of ALT. Serves as support to the Executive Director as well as provider members and staff.

Responsibilities:

• Maintains consistency with Administrative and Departmental policies with appropriate behavior, dress, attitude, attendance, confidentiality, professionalism, and reliability
• Serves as a resource to the Executive Director, providers, office staff, hospitals, and facilities participating in ALT
• Establishes and maintains professional relationships with Administration, ALT physicians and office staffs, ALT hospitals and facilities, and ALT contracted payers
• Responsible for processing new ALT provider packets, including contracts and ballots
• Sends notices and counter-offers to ALT payers as appropriate
• Serves as a resource to participating ALT physicians and office staff by resolving payer participation issues and contract specific issues
• Serves as a resource to participating ALT hospitals and facilities by resolving Payor participation issues, contract specific issues, and claims issues
• Responsible for creation of Payor ballots, and the balloting process for new Payor agreements
• Responsible for preparing articles and informational items for bi-monthly newsletter published by ALT
• Responsible for the monthly review of several Payor and governmental websites to determine any updates or changes in policies that may need to be communicated to the ALT network
• Responsible for the creation of monthly managed care activity reports and comparison to previous month activity to be sent to the Administrative Team and various CSMHS Business Office associates
• Provider Enrollment Specific Responsibilities:
  • Assist in any provider enrollment for ALT providers
  • Collects and maintains data on providers for payor plan enrollment.
  • Prepares and submits applications to payors for new provider enrollments and existing provider updates; follows up by telephone or in writing, with carriers regarding application status
  • Follow up with payors to secure provider approval through provider number assignment. Enter approval information into ECHO so billing department can be notified to release claims.
  • Complies with payor enrollment guidelines.
  • Provides ongoing provider enrollment maintenance of CSM HOPD and ALT PHO providers, as applicable, after enrollment approvals and effective dates are received. (i.e. CAQH – every 90 days; TMHP – license expirations as they occur; Medicare re-attest – every 5 years; Commercial plan re-credentialing – every 3 years)

Requirements:

Education/Skills

• High School Diploma or equivalent required
• Bachelor's degree preferred

Experience

• 1-3 years experience in provider enrollment/insurance

Licenses, Registrations, or Certifications

• None required

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time