Job description
Overview:
Responsible for maintaining payor demographics and supporting payor credentialing business processes. This role is also responsible for supporting PRNI Operations to ensure that contracted payors are credentialed timely and notified timely and accurately of any type of changes.
Responsibilities:
- Engages and follows up with payors on credentialing and/or contract status approval as appropriate, effective date and demographic loads, and notifying the appropriate internal stakeholders of statuses obtained.
- Coordinates with the PSR and PSS to update demographic rosters for payors as needed for credentialing, proactively send/notify payors of demographic updates as required by contract and proactively audit payor systems via website, portal, and/or engagement with credentialing department/representatives. Identifies any process improvements to enhance generation of care center roster.
- Monitors emails in the Managed Care and Payor Contracting email box. Creates and/or supports Helpdesk tickets as appropriate.
- Maintains and updates business process related policies and procedures, workflows and other educational and training documentation as approved by the Director. Ensures documentation is maintained and reviewed for accuracy by all relevant internal teams. Proactively initiates collaboration with team members to draft new policies and update existing policies and submits for appropriate approvals.
- Opens daily incoming mail and distributes accordingly.
- Assists with preparing outgoing mail, including mail merge, certified mail, and Fed Ex methods.
- Assists with coordinating payor contract folders on the department's hard drive and maintaining consistency.
- Supports team members as a liaison by utilizing external websites, internal data systems and other avenues necessary with payors, care centers and internal departments for accurate administration, maintenance, education, and proactive interventions to aid in operational improvement.
- Performs other duties as assigned.
Required
- High school diploma or equivalent.
- Two (2+) years' experience in a medical office, hospital, or managed care setting (health plan) performing in an administrative function.
- Ability to effectively problem solve, prioritize, and communicate.
- One (1+) year experience with responsibility of Policies Procedures related to proof reading, monitoring process for changes that might require updates, maintaining current and relevant documentation of established business processes, effectively demonstrating high quality and attention to detail and accuracy.
Preferred
- Post-secondary education or training in business related field.
- Experience in managed care, or healthcare setting.
Amedisys is an equal opportunity employer. All qualified employees and applicants will receive consideration for employment without regard to race, color, religion, sex, age, pregnancy, marital status, national origin, citizenship status, disability, military status, sexual orientation, genetic predisposition or carrier status or any other legally protected characteristic.
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