What are the responsibilities and job description for the Provider Contracting Assistant (Hybrid - Troy, MI) - Health Alliance Plan position at Henry Ford Health - Careers?
GENERAL SUMMARY:
Coordinate processing and maintenance of provider contracts and maintenance of provider demographic information including new contracts, terminations and modifications, and configuration of Contract Manager, Facets or its successor systems. As a team member, provide administrative support, coordinate, and prepare appropriate correspondence/contracts/audits for regulatory agencies, network maintenance projects, and strategic initiatives.
DUTIES & RESPONSIBILITIES:
- Conduct activities to enroll providers for participation with HAP including pre-screening, preparing, and sending credentialing applications and contracts to providers, coordinating with delegated networks, and maintenance of tracking logs of all provider enrollments.
- Prepare contracts in the Contract Management System, send contracts to providers, and track contracts through approval process.
- Prepare Provider Reimbursement Worksheets (PRW’s) and or Ancillary Reimbursement Worksheets (ARWs) in accordance with departmental procedures for provider enrollments, terminations, demographic changes or other modifications.
- Assist department with all Single Case Agreements, regulatory reporting and audits, and special projects as needed.
- Resolve provider enrollment and provider inquiries in assigned Pega workbasket. Maintain caseload in Pega workbasket and email boxes on a regular basis.
- Assist department staff with telephone triage, field provider calls and direct as appropriate, assist internal departments with provider inquiries and reimbursement verification.
- Assist and participate in the interpretation, summarization, communication, and recommendation on key elements of provider contracts to the appropriate individuals both internal and external to the organization.
- Assist and participate in timely triage and resolution of provider issues.
- Assist and assume responsibility for focused projects within the department relating to provider contracting.
- Perform other related duties as assigned.
Education/Experience Requirements:
- High School Diploma required.
- Two (2) years of college with courses in business, or computer related program preferred.
- Minimum of two (2) years of health care experience required.
- Minimum of two (2) years of Provider Relations/Provider Contracting experience.
- Strong working knowledge of computer systems and personal computers.
- Knowledge and experience of a managed care organization's operations are required.
- Knowledge of physician reimbursement methodologies is preferred.
- Analytical and problem-solving skills.
- Must possess organizational and time management skills.
- Self, motivated with effective communication and interpersonal skills.
- Knowledge of HAP's provider system preferred.
- Knowledge of Excel and Microsoft Word.
Additional Information