PURPOSE AND SCOPE:|
Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements.
Works independently to coordinate, develop, monitor and maintain the credentialing process under the limited supervision of the Director Payer Relations & Contracting .
DUTIES / ACTIVITIES:
Responsible for driving the FMS culture through values and customer service standards.
Accountable for outstanding customer service to all external and internal customers.
Develops and maintains effective relationships through effective and timely communication.
Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.
PRINCIPAL RESPONSIBILITIES AND DUTIES:
Complete and processes provider applications, using verifications from the AMA, NPDB, state medical board websites and other document verification.
Detailed work with review and follow up determines eligibility by applying FVC, TJC and regulatory company standards as they relate to our physicians.
Analyzes and resolves provider file issues, tracks progress on and produces reports in One-App for credentialing management.
Reviews and analyzes provider file changes. Administers data using One-App.
Maintains/updates CAQH as required.
Responds to external inquiries received by letter, phone, or internal departments.
Administers Re-credentialing of FVC providers.
Maintain The Joint Commission certification regulatory guidelines regarding physician privileging.
Pull and maintain payer fee-schedules for all FVC sites/localities
Other duties as assigned.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
The physical demands and 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.
Day to day work includes desk and personal computer work and interaction with patients, facility staff and physicians.
High School Diploma required.
Associates Degree or certificate program preferred.
EXPERIENCE AND REQUIRED SKILLS:
Minimum 3 years required experience in healthcare administrative role, working with physicians and related administrative functions.
Must be proficient with standard desktop office applications including Microsoft Office software applications.
Must have excellent and effective verbal and written communication skills to communicate with providers, office staff and insurance companies.
Must perform work at a high level of accuracy and within the required timelines.
Must have good organizational skills with the ability to manage multiple tasks and prioritize.
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