Northern Light Health

Department: Credentialing

Position is located: Cianchette Professional Blding

Work Type: Full Time

Hours Per Week: 40.00

Work Schedule: 8:00 AM to 5:00 PM

Summary:

The Provider Management Specialist is responsible for coordinating with Provider Management Platform on all aspects of provider credentialing and enrollment. This individual is the day-to-day contact for Provider Management Platform’s Operations Team, primarily to initiate requests - credentialing or enrollment requests - for the Provider Management Platform to process.

Responsibilities:

Payer Enrollment

• Initiate health plan enrollment requests. This includes group, individual, Medicare, Medicaid, commercial, and managed care health plans.

• Ensure The Provider Management Platform is adhering to contracts SLAs.

• Ensure The Provider Management Platform has all supporting documentation in provider profiles. This includes all onboarding documents, application copies, welcome letter, and other correspondence.

Credentialing

• Ensure The Provider Management Platform is adhering to contracts SLAs.

• Reviewing credentialing files and report on committee approval progress.

• Resolve day-to-day questions and blockers for your team and escalate priority issues when needed.

Other Responsibilities

• Individual(s) will work closely with the Provider Management Platform Engagement Management team by participating in weekly, monthly and quarterly reviews of immediate action items and quarterly reviews.

• Individual(s) assist in communications for any escalations that are needed within the Client's organization.

• Individual(s) participate and help coordinate The Provider Management Platform training and quarterly best practices review.

• Individual(s) will develop and maintain a working knowledge of the statutes and laws relating to credentialing. Responsible for interpretation and compliance with the appropriate accrediting and regulatory agencies.

• Individual(s) will utilize The Provider Management Platform’s to report and monitor all provider workflows to validate deliverables (completed profiles, credential files and payer enrollments) and performance metrics (TATs and SLAs).

• Individual(s) have knowledge of Records Management, with an ability to maintain or update assigned physician files, updating each item/action as presented in The Provider Management Platform.

• Individual(s) assist in communications for any escalations that are needed within the Client's organization.

• Other Duties.

Other Information:

• NAMSS CPCS Certification or within 12 months.

• 2+ years familiarity with payer enrollment related applications and processes.

• 2+ years familiarity with credentials verification.

• Detail oriented and able to ensure the complex enrollment packages are complete and correct.

• Able to communicate well with a wide variety of internal and external contacts at all levels of the organization.

• Must be able to work cohesively in a team-oriented environment and be able to foster good working relationships with others both within and outside the organization.

Competencies and Skills

• Achieves Results: Sets high standards for their own outcomes and seizes opportunities to engage others towards objectives. Consistently moves forward with direct actions in order to attain or exceed objectives. Manages their own time effectively to accomplish assigned tasks. Successfully prioritizes multiple projects and duties as needed.

• Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.

• Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.

• Demonstrates Adaptability: Learns quickly when facing a new problem or unfamiliar task; is flexible in their approach with changing priorities and ambiguity. Manages change effectively and does not give up during adversity. Capable of changing one's behavioral style and/or views in order to attain a goal. Absorbs new information readily and puts it into practice effectively.

• Demonstrates Emotional Intelligence: Exhibits a high level of self-awareness, self-management, other awareness and relationship management. Conducts themselves in an empathic, appropriate way, with a sense of humor and stimulates a collaborative work environment. Is respectful of the attitudes, feelings, or circumstances of others and aware of the influence of their own behavior on them. Is aware of relevant social, political, system, and professional trends and developments and uses this information for the organization's benefit.

• Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.

• Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.

• Types at 60+ words per minute. (only to be used as a condition of employment)

• Spreadsheet application with the ability to use calculations, formulas, graphing tools, pivot tables, and a macro programming.

• Word processing, spreadsheets, data entry, database experience and other computer related skills.

• Email application with the ability to manage email as well as calendars, managing tasks and contacts, note taking, journaling, and web browsing.

• Presentation software with the ability to create presentations with the ability to incorporate animation, audio, video, time delays, as well as designing themes and variants with animations and effects.

• MS Teams

• Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

• Serves Others: Strives to understand, meet and exceed the expectations and requirements of internal and external customers which may include the people and communities in our service areas. Develops and maintains relationships, alliances and coalitions within and outside the organization and leverages them in order to obtain information, support, and promote cooperation and collaboration.

• Utilizes Resources Effectively: Understands how to get the most out of available resources and uses cost-benefit thinking in decision-making and in setting priorities. Monitors and analyzes resource usage to identify and eliminate areas of waste and maximize resources. As a leader, defines targets and provides appropriate means; oversees progress and makes adjustments when necessary. Appropriately delegates work, sets clear direction and manages workflow and time.

• Zoom

Education

• Required High School Diploma/General Educational Development (GED)

Required Experience

• 2 year/years of Relevant Work Experience

Working Conditions

• Work with computers, typing, reading or writing.

Position Provider Management SpecialistLocation Req ID null