Provider Materials Coordinator
will create Primary Care Network Listings (PCNLs), directories and policies; ensure that the most recent and accurate provider information is listed including audits of the credentialing database. Collaborate with Government Programs to ensure all contractual requirements are met. Specific duties and responsibilities include:
Bachelors degree or equivalent in health care management or related field required. Related experience will be considered.
- Oversee PCNL and directory productions by monitoring accuracy, adherence to deadlines, and effectiveness of DirectoryExpert.Develop and maintain procedures and /or policies related to accurate production of PCNLs and Directories.
Ensure compliance with State and Federal regulations and contract requirements.
- Maintain monthly audits of credentialing software and delegated information received for directories.
Maintain the criteria for setting up providers into the credentialing software.
- Monitor network access and availability standards by generating quarterly GeoNetwork maps and reports to ensure contractual compliance. Produce a quarterly report identifying network access and availability standards are / are not met.
- Department lead for CMS expansion applications, DHS RFP's and MDH audits.
- Produce Member Accessibility Analysis Binders for audit readiness for network expansions.
- Work with UCares website auditor to ensure directory search functions are appropriate.
- Assist with coordination of delegated credentialing processes including: communication with delegated contacts, conducting annual audits, data entry of delegate profiles, and monthly follow-up on overdue profiles per regulatory requirements.
- Assist with entry of delegated profiles, InfoPath Forms and assigned Service Forms.
- Assist with the review of credentialing/recredentialing applications for required information, request missing information from providers, as necessary, conduct primary source verifications, when applicable, review data entry in credentialing database, document required information using the checklist, assure the file is in correct order and refer completed application to appropriate committee, working with Medical Directors as needed.
- Assist with auditing the credentialing system and creating queries and reports.
This position requires three to five years experience in a health delivery setting, such as physician group practice, health insurance, HMO or community service agency. At least one year of experience related to Health Plan operations is required. Above average Microsoft software skills are also required.
Project management experience is preferred.
UCare - 17 months ago
UCare provides more than 160,000 Minnesotans with the health coverage plans and services they need to maintain and improve their health....