PROVIDER RELATIONS & FACILITY CREDENTIALING SPECIALIST (94000333) at Eskenazi Health in Indianapolis, Indiana

Job Description:

Division:Eskenazi Health



Sub-Division:Hospital



Req ID:22069



Schedule:Full Time



Shift:Days


Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 333-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus including at a network of Eskenazi Health Center sites located throughout Indianapolis.




FLSA Status



Non-Exempt




Job Role Summary



The Provider Relations Facility Credentialing Specialist is responsible for the tracking deliverables and completion of all forms and related processes required to ensure that all Eskenazi Health service locations and providers are appropriately credentialed in order to be "in network" for all contracted payers. This position is responsible for understanding the complex enrollment structure that covers over 540 providers at more than 40 enrolled locations. This position is responsible for maintain a high level of knowledge of all contracted payor requirements specific to credentialing and enrollment as well as understanding NCQA guidelines. Through education, problem solving and follow-up the Provider Relations Specialist helps providers and their offices participate effectively in enrolled payor plans and ensures accurate reimbursement of claims. This position will work closely with other departments including the Director, Managed & Value Based Care Eskenazi, legal, regulatory and operational leaders across the organization as well with external contacts for over 16 contracted payers as well as any new payer that are contracted by Eskenazi in order to ensure appropriate credentialing and enrollment of all service locations and to support related delegated credentialing and enrollment processes in order to ensure appropriate reimbursement of claims for services rendered.




Essential Functions and Responsibilities



Responsible for initiating contact with payor in order to establish rapport and obtain clear understanding of the forms and supporting documentation required for completion of facility and provider credentialing forms to establish the facility and the providers as in network for new contracts.
Responsible for creating and maintaining a dashboard to track key deliverables and due dates required to ensure that all locations and providers are identified as in network for new payer contracts.
Works with EPIC, Billing, Provider Enrollment and Delegated Credentialing Specialists and other team members to ensure all team members are aware of the new contract and requirements to complete delegated credentialing and enrollment for providers.
Responsible for completion of monthly audits in collaboration with other team members to ensure that providers are reflected accurately on all provider PAR (in network) rosters and external public facing directories.
Verify, maintain and submit managed care directory attestations and verifications as designated by MCEs to ensure that information correctly represents the providers and locations displayed in the directory by the payor
Responsible for maintaining ongoing, current knowledge of all Federal and State Laws and regulations, payor regulations, NCQA, contractual requirements and other industry standards.
Work with Revenue Cycle Team members and other departments to ensure compliance with payor credentialing and contract requirements pertaining to provider enrollment and directories.
Collaborate with Provider Enrollment Specialists, Billing and others to ensure appropriate enrollment, paneling and credentialing and to assist in resolution of issues impacting Quality, Contracting, Enrollment, MCE's and other stakeholders
Direct and implement strategies for dissemination and training of educational materials, standards of work, and process flows to providers, billing teams and others related to enrollment and claims processing issues
Work with operational leaders, HR, Legal and others as needed to obtain information needed specific to malpractice, exclusions, licensure, accreditation, ADA compliance and other information required for facility/provider credentialing with payors.
Review provider enrollment lists and other internal and external reports to ensure the accuracy of information.
Completes routine, ongoing review of payor rosters to ensure that enrollments are reflected on rosters/directories accurately and timely.
Acts as liaison between EH/EHC/EMG and the managed care entities with respect to panel management and supporting activities.
Assist EH/EHC medical practices by addressing issues impacting operations. Elevate issues to Senior Leadership or appropriate parties to find a resolution.
Represent EH/EHC/EMG by attending and participating in payor meetings, conferences, or educational sessions related to Medicare or Medicaid, or Marketplace products.




Job Requirements

• Bachelor's degree in a related field such as healthcare administration, social work, public health, sociology, or business is required. Master's degree preferred. In lieu of degree, 5 years of related experience required


• Experience working with provider relations, physicians, insurance, social programs or MCOs


• Experience with Medicare, Medicaid or Government programs


• Lean Six Sigma Green Belt/Black Belt certification strongly valued.


• Must have access to a reliable motor vehicle and possess a valid Indiana Driver's License.

Knowledge, Skills & Abilities

• Must have knowledge of NCQA guidelines for initial and re-credentialing


• Must have knowledge of Medicare and Medicaid and other payor guidelines and requirements specific to provider and facility enrollment and delegated credentialing.


• Must be attentive to details and ability to follow complex procedures


• Communicate effectively with wide variety of staff in including peers, operational leaders, providers (physicians, mid-level licensed staff, & Advanced Practice Professionals)


• Ability to work independently and exercise professional judgment to meet daily operational demands


• Ability to work effectively under pressure and accept responsibility for decisions


• High level of experience working in Microsoft Office suite applications including Excel, Word, and Power Point

Accredited by The Joint Commission and named as one of Indiana's best employers by Forbes magazine for two consecutive years and the top hospital in the state for community benefit by the Lown Institute, Eskenazi Health's programs have received national recognition while also offering new health care opportunities to the local community. As the sponsoring hospital for Indianapolis Emergency Medical Services, the city's primary EMS provider, Eskenazi Health is also home to the first adult Level I trauma center in Indiana, the only verified adult burn center in Indiana and Sandra Eskenazi Mental Health Center, the first community mental health center in Indiana, just to name a few.



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