7560- FPO Faculty Practice Org
Officer Full-Time Regular
If temporary, indicate duration
Hours Per Week
Commensurate with experience
Advertised Summary Job Description
Responsible for reviewing, inputting and tracking high volume Provider credentialing applications to ensure timely and efficient enrollment of eligible providers in the ColumbiaDoctors network and respective contracted managed care plans. Develop and maintain relationships with Managed Care Representatives and internal staff. Review and route all membership applications and affiliated documents according to PEG policies and procedures. Respond to provider inquiries with regard to application explanation and status. Ensure the prompt data entry of initial physician records in the PEG database, production of eligibility lists for payors participation, and submission/follow-up of provider disenrollment or opt-outs from payor plans. Responsibilities include: 1. Process new provider enrollment requests from departments in a timely fashion. Review all data/documents entered for accuracy. Provide feedback to departments per PEG policy and procedures regarding missing or incomplete data/documents. 2. Submit all documents for credentialing/recredentialing to appropriate parties in a timely manner. Review all documents prior to submission to ensure completion and accuracy. 3. Update PEG database accurately to reflect all steps taken. Responsible for follow-up of applications, delegated spreadsheet submissions, updates and terms returned to physician or designee for missing information. Inform manager of delays related to enrollment/credentialing/recredentialing processing both internally and externally. 4. Update PEG database to reflect provider opt-in/opt-out selections for managed care participation per PEG policy and procedures. 5. Upon enrollment in managed care plans, update database with accurate provider identification numbers. Inform physician or designee in a timely fashion. Verify correct loading of physician demographic and tax identification information in payor system. Produce reports for review by departmental administrators and billing office personnel. 6. Submit demographic updates to managed care plans as requested in timely manner per PEG policy and procedures. Track confirmations as received, update database, and inform departments accordingly. 7. Manage the ongoing process required for physician disenrollment or opt outs from managed care plans, change of ColumbiaDoctors level of affiliation, and exclusivity waivers for ColumbiaDoctors members. Maintain an understanding of the various faculty affiliations and takes appropriate action steps. 8. Review provider participation rosters and compare information to PEG database. Follow up with payors for verification and completes reconciliations accordingly. Review and correct provider demographic information prior to printing of payor Provider Directories. 9. Establish and maintain positive relationships with physicians, administrators and Managed Care Organization representatives. 10. Log and track departmental issues as related to enrollment, credentialing, and demographics; exchange trackers with department on a regular basis. 11. Escalate departmental issues to Enrollment Manager and/or Director appropriately. Hold conference calls or face-to-face meetings with departmental contacts on an as needed basis, including Enrollment Manager if deemed appropriate. 12. Provide enrollment, credentialing, and demographic reports to departments on a routine basis; provide additional reports to departments as requested. 13. Assist with credentialing, enrollment and operational projects as needed.
Minimum Qualifications for Grade Applicant MUST meet these minimum qualifications to be considered an applicant
Requires a bachelor's degree or equivalent in education, training and experience, plus two years of related experience.
Additional Position-Specific Minimum Qualifications Applicant MUST meet these minimum qualifications to be considered an applicant
Specialized knowledge of Credentialing/Enrollment required. One to three years experience in the use of relational databases and their supporting programs in Microsoft software. Working knowledge of Microsoft Word, Excel, Access or comparable word processing and spreadsheet software. Attention to detail a must. Customer service orientation a must. Time management and multi-tasking skills required. Communication skills, organizational skills, and ability to prioritize.
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
Columbia University is an Equal Opportunity/Affirmative Action employer.
Columbia University is committed to the hiring of qualified local residents.
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