The Managed Care Network Specialist acts as a liaison with NMFF practices, physicians, management, revenue cycle team, NHC/NMH credentialing and managed care payers to facilitate positive and clear communication, excellence in service and provides accurate and timely information to support the managed care function. Develops agendas for meetings, including routine meetings with managed care payers and is responsible to make sure all information is gathered and distributed in preparation for the meetings. Maintains and updates provider roster for NMFF, collects credentialing\re-credentialing applications and information. Ensures providers are appropriately credentialed with managed care payers by working collaboratively with NHC and maintains a tracking and follow up system for the application process. Works with physician practices and legal staff to support the enhanced medical appeals process by review of cases being requested for appeal and obtains documentation required based on guidelines that have been established.
EDUCATION, LICENSURE/CERTIFICATION & EXPERIENCE
-Bachelor's degree or equivalent relevant experience.
-Minimum 2 years relevant work experience, preferably in a managed care setting or large multispecialty group practice.
PERSONAL CHARACTERISTICS & COMPETENCIES
Include specific characteristics and competencies that will be critical to success (such as the following):
-Excellent interpersonal skills, including the ability to establish and maintain effective relationships with managed care payers, physicians, management, staff and other customers.
-Strong attention to detail and ability to produce accurate reports.
-Excellent verbal and written communication skills.
-Ability to use personal computers and NMFF software applications.
-Self-directed and can effectively handle challenging situations and balance multiple priorities.
-Proficient with Microsoft Access, Excel and Word software.
-Ability to develop presentations and preferred experience with Microsoft PowerPoint.
-Strong project management skills and ability to communicate results.
-Ability to adapt to changing environments and role requirements.
Weekly Scheduled Hours:
Northwestern Medical Faculty Foundation - 14 months ago
Northwestern Medical Faculty Foundation is a physician practice organization offering scholarly care to patients in the Chicago area. The...