Credentialing Liaison

POSITION SUMMARY:

Your primary responsibilities include managing relationships with our third-party vendors; ensuring data is accurately entered into systems; documents are collected timely, and providers are transitioned to our third-party vendors within established timeframes to meet a providers start date.  This involves reviewing systems, reports, emails and escalating any issues/concerns to the leadership team.  

ESSENTIAL FUNCTIONS: To perform this job, an individual must perform each essential function satisfactorily with or without reasonable accommodation.

• Work independently to establish, build, and improve relationships with third-party vendors.
• Be the third-party vendor’s primary point of contact, answering their questions, and addressing their concerns within established timeframes.
• Schedule, facilitate, and document weekly meetings with third-party vendors to ensure providers are being credentialed and recredentialed timely and efficiently.
• Collaborate with internal and external customers; problem-solve any issues that arise and remove barriers that impede the completion of the providers payer credentialing and recredentialing process.
• Work closely with third-party vendors and PhyNet billing team to resolve denied or pended claims.
• Implement, document, and maintain standard operating procedures to ensure compliance with payer state and federal guidelines.
• Review, track and trend payer issues to identify areas of improvement.
• Knowledge and understanding of the hospital credentialing and recredentialing process.
• Knowledge and understanding of payor credentialing to include Medicare, Medicaid, BCBS, IPA, and commercial insurance processing.
• Liaison experience.

EXPERIENCE:

• 3-5 years of experience in medical credentialing and privileging procedures and standards.
• Knowledge of related accreditation and certification requirements.
• CPCS Certification preferred.
• Ability to make administrative/procedural decisions and judgments.
• Ability to investigate and analyze information and draw conclusions.
• Ability to process computer data and to format and generate reports.
• Ability to communicate effectively, both orally and in writing.
• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
• Skill in developing policy and procedure documentation.
• Database management skills.
• Employee development and performance management skills.

PHYSICAL AND MENTAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential job responsibilities.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit for extended periods of time; use hands to finger, handle or fell objects, tools, or controls; reach with hands and arms; climb stairs; balance, stoop, kneel, bend, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift, push, pull and/or move up to 20 pounds. Required specific vision abilities include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.