7560- FPO Faculty Practice Org
Officer Full-Time Temporary
If temporary, indicate duration
no more than two years
Hours Per Week
Commensurate with experience
Advertised Summary Job Description
Responsible for reviewing, inputting and tracking high volume demographic updates to ensure timely and efficient updates to the PEG database and managed care plans. Develop and maintain relationships with Managed Care Representatives and internal staff. Review and route all applications and affiliated documents according to PEG policies and procedures. Respond to provider inquiries with regard to demographic update and application explanation/status. Ensure the prompt data entry of initial physician records in the PEG database, demographic updates, production of eligibility lists for payors participation, and submission/follow-up of provider disenrollment or opt-outs from payor plans. Responsibilities include: 1. Submits demographic updates to managed care plans as requested in timely manner per PEG policy and procedures. Tracks confirmations as received, updates database, and informs departments accordingly. 2. 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. 3. Submit all documents for demographic updates and credentialing/recredentialing to appropriate parties in a timely manner. Review all documents prior to submission to ensure completion and accuracy. 4. 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. Informs manager of delays related to demographic updates and enrollment/credentialing/recredentialing processing both internally and externally. 5. Update PEG database to reflect demographic updates and provider opt-in/opt-out selections for managed care participation per PEG policy and procedures. 6. Upon new enrollment and updated enrollment in managed care plans, updates database with accurate provider identification numbers. Informs physician or designee in a timely fashion. Verifies correct loading of physician demographic and tax identification information in payor system. Produces reports for review by departmental administrators and billing office personnel. 7. Manages the ongoing process required for physician demographic updates, disenrollment or opt outs from managed care plans, change of ColumbiaDoctors level of affiliation, and exclusivity waivers for ColumbiaDoctors members. Maintains an understanding of the various faculty affiliations and takes appropriate action steps. 8. Reviews provider participation rosters and compares information to PEG database. Follows up with payors for verification and completes reconciliations accordingly. Reviews and corrects 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. Logs and tracks departmental issues as related to enrollment, credentialing, and demographics; exchanges trackers with department on a regular basis. 11. Escalates departmental issues to Enrollment Manager and/or Director appropriately. Holds conference calls or face-to-face meetings with departmental contacts on an as needed basis, including Enrollment Manager if deemed appropriate. 12. Provides enrollment, credentialing, and demographic reports to departments on a routine basis; provides additional reports to departments as requested. 13. Assists 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. 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 required.
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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