7560- FPO Faculty Practice Org
Officer Full-Time Regular
If temporary, indicate duration
Commensurate with experience
Advertised Summary Job Description
Reporting to the Chief Revenue Cycle Officer of the ColumbiaDoctors FPO, primary responsibilities include management of all administrative and operational affairs of the Physician Enrollment Group (PEG). Other responsibilities include but not limited to: supervision of staff, management of delegated process, oversight of enrollment process into contracted and other insurance plans and management of credentialing database. Responsibilities: 1. Management and oversight of PEG Office. Interface with Clinical Revenue Office (CRO) and ColumbiaDoctors Information Systems (CDIS) to develop best practice processes for delegated and non-delegated participation in plans that is fully integrated with all related revenue cycle components. 2. Interface with Hospital, University personnel and external Managed Care Organizations/Plans to represent physician interests in credentialing, participation (& non) in contracted plans and select non contracted plans. 3. Supervise administrative and support staff, including but not limited to, Enrollment, Database, Website personnel and external vendors. Implement efficient work procedures and processes to ensure timely enrollment of ColumbiaDoctors providers as well as maintain compliance with Delegated Credentialing and Master Participation Agreements with plans. Measure and manage staff productivity. 4. Directs and supports the ColumbiaDoctors Credentialing Committee and all functions related to Delegation, including but not limited to negotiation of delegation agreements, maintenance of policies and procedures, annual audits and quarterly reporting. 5. Oversees reconciliation of provider rosters with Managed Care Organizations (MCO) and Departments to ensure correct linkage for proper MCO reimbursement. 6. Develop and manage operational budget for PEG. 7. Integrate PEG functions/initiatives into overall strategy and vision for ColumbiaDoctors. 8. Continuously seek improvements to PEG operations. Identifies and develop areas for improvement. 9. Initiate and develop departmental communication activities including newsletter, forums, programs, secure server and website content. Develop useful tools and resources for clinical departments. 10. Oversees quality assurance and maintenance of credentialing database integrity. 11. Participate in ad hoc committees, leadership forums and other activities as requested. 12. Facilitate resolution for escalated inquiries from physicians, administrators, managed care contacts and staff. 13. Develop performance indicators for payer compliance and monitor key changes and trends in credentialing by major payers with impact to enrollment.
Minimum Qualifications for Grade Applicant MUST meet these minimum qualifications to be considered an applicant
Requires a bachelor's degree or equivalent in education and experience, plus seven years of related experience (i.e., health care management and managed care experience).
Additional Position-Specific Minimum Qualifications Applicant MUST meet these minimum qualifications to be considered an applicant
Experience with managed care operations, computers, databases, and word processing required. Excellent oral and written communications skills. Ability to maintain multiple projects simultaneously. Exceptional analytical and organizational skills. Effective supervisory skills/techniques.
Masters degree preferred. Prior experience in an academic medical center preferred.
Special Indications This position works with:
There are no special indications for this position
HIPAA Compliance training required
Participation in Medical Surveillance required
What type of posting? Is this a waiver request?
Requisition Open Date
Requisition Close Date
Open Until Filled
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