Provider Relations Coordinator
AIDS Healthcare Foundation - Fort Lauderdale, FL

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AMAZING INDIVIDUALS WORKING FOR POSITIVE PEOPLE...at AIDS Healthcare Foundation! Does the idea of doing something that really makes a difference in people's lives while being well compensated intrigue you? Are you looking to work for an organization that encourages growth and success from each and every one of its employees? If so, AIDS Healthcare Foundation is the place for you! Founded in 1987, AIDS Healthcare Foundation is the largest specialized provider of HIV/AIDS medical care in the nation. Our mission is to provide cutting edge medicine and advocacy, regardless of ability to pay. Through our healthcare centers, pharmacies, health plan, research and other activities, AHF provides access to the latest HIV treatments for all who need them. AHF's core values are to be: o Patient-Centered o Value Employees o Respect for Diversity o Nimble o Fight for What's Right STILL INTERESTED? Please continue! Essential Duties & Responsibilities Includes the following. Other duties may be assigned. o Support efforts of Provider Relations and Credentialing in ensuring accurate and complete provider demographics, including all information needed for the acceptance of encounters, provider network files, and enrollment files by CMS and DMHC. o Responsible for entering initial credentialing, demographic and contract information in PHP/PHC MIS system for newly contracted providers, delegated provider groups and non-contracted providers. o Responsible for accuracy and completeness of provider information in PHP/PHC MIS system by tracking terminations and additions to provider network and remediating or completing any information needed not included on files supplied by various PHP/PHC network affiliates. o Responsible for contacting network providers and updating demographic information in the MIS system on a regular basis and analyzing exception reports when provider information included on submitted files and information resident in MIS system conflicts. o Responsible for working with Provider Relations Department on cataloguing and updating contract files. o Responsible for working with Provider Relations and MIS Departments on submission compliance of required regulatory and other regularly scheduled network reports, including provider terminations and additions, and provider directories. o Responsible for generating ad-hoc provider reports, LOA's, and Provider Agreements. o Responsible for maintaining 3rd Party Contracting grid and will act as a liaison to 3rd party vendors. o Responsible for working with MIS departments on monthly update of provider network files on websites in compliance with CMS and AHCA. o Responsible for distributing various notices of provider network changes to appropriate departments and providers. o Responsible for auditing the Provider Directories on a monthly/quarterly basis. o Responsible for logging Provider Grievances and generating acknowledgement and resolution letters to providers. o Responsible for maintaining current provider files, including incoming/outgoing correspondence. Participation in AHF Meetings/Committees Managed Care Staff Meeting Weekly Provider Relations Meeting Various Provider Relations training and staff meetings Other meetings/committees as assigned Supervisory Responsibilities This job has no supervisory responsibilities. Qualifications 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. Education and/or Experience Associate's degree (A.A.) or relevant experience in data management and customer service. Computer/Software Skills & Abilities To perform this job successfully, an individual should have knowledge of MS Office programs as well as experience with health plan MIS systems Other Skills and Qualifications Ability to read, analyze, and interpret spreadsheets including member and provider demographic information. Ability to effectively communicate and present information to PR, MIS and enrollment departments. Mathematical Skills Intermediate Skills Reasoning Ability Very High Skills: Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. o Ability to summarize analytical results in Crystal Reports, MS Excel, PowerPoint, etc. o Proficient and demonstrated use of database reporting tools for data manipulation, data extraction, merging of large, complex data from variety of sources. o Prior experience with EMR (Electronic Medical Records) databases.

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AIDS Healthcare Foundation - 21 months ago - save job - block
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