Bachelor’s Degree required or equivalent work experience.
Required 5 years of industry and topical related experience.
Must possess strong understanding of the local managed care environment, including, but not limited to, managed care policies and procedures, reimbursements mechanisms, and practice management/medical office procedures.
• Excellent communication skills, demonstrated organizational skills, ability to multi-task.
• Strong interpersonal skills. Must be organized and detail-oriented.
• Ability to work independently, achieves specific goals and objectives, and provides recommendations for improvement.
• Ability to work collaboratively with a strong orientation for bottom line results.
• Excellent written and oral (presentation) skills.
• Knowledge of computers, specifically healthcare, word-processing and spreadsheet applications.
All CHOP employees who work in a patient building or who provide patient care are required to receive an annual influenza vaccine unless they are granted a medical or religious exemption.
• Child Abuse Clearances
• FBI Fingerprint Clearance
• Drug Screening
The Managed Care Credentialing and Response Specialist (MCCRS) acts as a liaison between Managed Care Organizations (MCOs) and CHOP’s Primary Care and Behavioral Health practices. The position has responsibility for coordinating and facilitating physician and site credentialing, reimbursement, claim payment and capitation incentives that impact the physician practices. The Credentialing and Response Specialist is responsible for developing an ongoing relationship with a specific set of MCOs and leveraging issues that aid in promoting CHOP, increasing cash flow, and decreasing administrative burden.
Job Responsibilities Principal responsibilities or job duties (no more than 5). Add paragraphs by clicking “ente.r.”
1. Maintains a positive and effective working relationship with all Managed Care Organizations (MCOs). Effectively promotes the need and interest of CHOP and fosters productive relationships with the MCOs. Minimizes payor conflicts through relationship building, defined accountability and ownership.
2. Works to analyze MCO Explanation of Benefits (EOB) responses to ensure contractual compliance. When discrepancies are discovered, the MCCRS will notify the MCOs, create files of global issues and work with MCOs to resolve any issues.
3. Educates office staff to managed care payment incentive programs used as a means to increase practice revenue. Establishes and maintains a positive working relationship with the ambulatory office managers, physicians, and office staff. Interacts with all individuals in the organization in a professional and customer-focused manner.
4. Works closely with the MCOs to ensure that practice and physician information is accurately identified by the MCOs during and after the credentialing process. Where discrepancies are found, the Managed Care Specialist works efficiently and effectively to resolve the issues.
5. Work to update the systems with accurate provider information. Develop and maintain practice billing information
6. Partners with the Corporate Managed Care (CMC) group to maintain a strong partnership so provider/practice issues can be identified and managed between the MSO and CMC.
7. Other duties as assigned.
Children's Hospital Philadelphia - 2 years ago
copy to clipboard
The Children's Hospital of Philadelphia (CHOP) is the nation's first hospital devoted exclusively to the care of children. Since our start...