Job Description
Job Description
POSITION SUMMARY
The Provider Network Administration Representative is responsible for managing relationships with healthcare providers within a network. The role involves ensuring that the providers are aware of the terms and conditions of their agreements with the network, and that they are complying with these terms. The representative is also responsible for ensuring that the providers are providing high-quality care to patients.
Position is onsite Monday-Friday.
ESSENTIAL DUTIES AND RESPONSIBILITIES
· Responsible for building and maintaining relationships with healthcare providers within the network, regularly communicating with providers, responding to their queries and concerns, and resolving any issues they may have.
· Ensuring that providers are complying with the terms and conditions of their agreements with the network.
· Monitoring provider performance, ensuring that they meet contractual requirements, and taking action if necessary.
· Evaluating the performance of providers within the network by analyzing data and metrics, conducting audits, and making recommendations for improvement.
· Developing strategies to improve the performance of the network.
· Identifying areas for improvement, setting targets, and implementing initiatives to achieve these targets.
· Maintaining accurate and up-to-date records of all providers within the network, including provider contracts, performance data, and other relevant information.
· Collaborating with other departments within the organization, such as customer service, claims processing, and provider relations, to ensure that providers are meeting the needs of patients and the network.
Network Support to include but not limited to:
· Review and process all new contracts and credentialing applications (documents such as contracts, applications, W9, and discloser of ownership forms).
· Email PR Reps or contact person from PR inbox when documents or information are missing.
· Create and/or enter all new individual providers and groups...including MSOs in the Company system
· Review and process all demographic changes, termination requests, pay to changes (W9) and fix any information that is NOT correct in the system (CORE). Email party if any information is either missing, incomplete or incorrect.
· Portal Registration Forms - review and process all requests coming from the PR Reps or PR inbox. Enter all new users in system and save all documents into the designated folder in SharePoint.
· Administer department email box which includes multiple requests. CAQH applications, demographic changes, Letter of intent, provider's credentialing status, Member Services open Tickets, Non-Par check status, non-Par billing changes with W9s.
· Process Letters of Intent: review and log into the SharePoint all emails and/or letters (Medical & Behavioral Health) coming from the PR inbox. Once a month create and send the NO THANK YOU letters to all those that were not approved by the PR team.
· Save all documents into the SharePoint designated folders once they 've been processed in the system.
Credentialing Support to include but not limited to:
· Review, process and send all credentialing applications and/or rosters that I received from the Network Prov Reps or via PR inbox emails.
· Log all applications and carefully reviewed to make sure that all required documents and information was received)
· Create and enter in the system all new providers and Facilities data submitted in the applications or via rosters.
· Staying in touch with the Cred Department's coordinator for credentialing status requests from our providers and/or Solis staff members.
QUALIFICATIONS AND EDUCATION
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
· Bachelor's degree in healthcare administration, business administration, or related field.
· Knowledge of healthcare and Medicare industry regulations, such as HIPAA, ACA, and CMS guidelines.
· Strong communication and interpersonal skills, with the ability to build relationships with providers.
· Analytical skills, with the ability to analyze data and identify areas for improvement.
· Attention to detail, with the ability to maintain accurate records and reports.
· Experience in provider network administration or related field preferred.
· Proficiency in Microsoft Office, particularly Excel and Access.
· Ability to work independently and in a team environment.
WORKING CONDITIONS
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
· The noise level in the work environment is usually moderate.
· Fast-paced office environment.
· Highly regulated environment.
· Interacts with patients, family members, staff, visitors, government agencies, etc, under a variety conditions and circumstances.
This work requires the following physical activities: climbing, bending, stooping, kneeling, reaching, sitting, standing, walking, lifting, finger dexterity, grasping, repetitive motions, talking, hearing and visual acuity. The work is performed indoors. Sits, stands, bends, lifts, and moves intermittently during working hours. May be sitting for a prolonged period.
The work schedule is approximate, and hours/days may change based on company needs. All full-time employees are required to complete forty (40) hours per week as scheduled, including weekends and holidays as needed. May require some OT during varying seasons of the year.
PHYSICAL 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 accommodations may be made to enable individuals with disabilities to perform the essential functions.
The employee must be able to frequently lift up to 10 pounds and occasionally lift and/or move up to 25 pounds. While performing the duties of this job, the employee is regularly required to talk or listen. The employee is frequently required to stand and walk. The employee is occasionally required to use hands to finger, handle, or feel; reach with hands and arms; climb or balance and stoop, kneel, crouch, or crawl. Specific vision abilities required for this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
PERFORMANCE MEASUREMENTS
· Duties accomplished at the end of the day/month.
· Attendance/punctuality.
· Compliance with Company regulations.
· Safety and Security.
· Quality of work.
This Job Description may be modified at any time at the discretion of the employer as business operations may deem necessary. This does not constitute an employment agreement and may not include all duties.
The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified. The incumbent must be able to work in a fast-paced environment with a demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate.