JOB PURPOSE:
This position will provide administrative and operations management oversight for all providers employed by assigned to PruittHealth Physician Services LLC (PruittHealth Premier and PruittHealth Physicians Services). This position also provides administrative support and operational oversight for credentialing and payer enrollment for employed providers and contracted providers at skilled nursing facilities.
KEY RESPONSIBILITIES:
Point person for all office communications for PruittHealth Physician Services; receives, triages and responds to calls, emails, voicemail, faxes and visitors
Processes department-based HR functions; includes but not limited to new hire processing, pre- employment screenings, new partner onboarding, electronic module review and training
Arranges set-up and training for provider EMR
Coordinates assignment/enrollment with billing company for Physician Services.
Verification of required licensure and certifications; Monitors licensure and certification requirements for PPS MD/NPs (GA, DEA, CPR, etc) and PruittHealth Premier providers.
Maintains personnel records and files per established guidelines
NP/MD credentialing: coordinates provider credentialing utilizing contracted vendor
Initiates credentialing for Physician Services, PruittHealth Premier providers, Hospice/Palliative Providers and all SNF contracted providers utilizing contracted vendor.
· Coordinates and responds to requests for credentialing both the application (initial) and reapplication (recred) process.
· Supports the credentialing verification efforts of the Credentialing Verification Office (CVO) by serving as a liaison or point of contact.
· Understands and utilizes CAQH and Andros systems to process credentialing requests, retrieve credentialing files and disseminate files as needed.
· Verifies credentialing requests for accuracy and works with requestors to submit timely to CVO
· Understands and maintains knowledge regarding the requirements regarding the credentialing process and payer enrollment.
· Corresponds and educates hospice and facility staff/providers on credentialing process and status updates of providers credentialing status. Maintains a system for tracking any pending/completed credentialing requests.
· Active member of the PruittHealth Credentialing Committee and provides requested information as needed to expedite committee decisions.
· Notifying Credentialing Verification Organization (CVO) and Payors of new and terminated providers and of any changes.
Initiates 3 rd party payer credentialing/enrollment utilizing multiple platforms - Madaket, PECOS, and GAMMIS/Medicaid for PruittHealth Physician Services and PruittHealth Premier as required. Initiates 3 rd party payer enrollment for Commercial Plans for Hospice/Palliative Providers using Madaket system.
· Completion and submission of forms/documents as necessary for completion of payor enrollment in Commercial Plans, Medicare and Medicaid in accordance with payor standards.
· Perform necessary follow-up and respond to all payer enrollment inquiries timely.
· Maintain accurate and current payer enrollment electronic files for physicians, physician assistants and NPs, i.e. licenses, DEA, CV, Malpractice Certificates, Business Licenses, and liability certificates, as needed.
· Research and work to resolve provider enrollment and credentialing related issues.
· Contacting payer by phone, requesting network participation and follow up on submitted applications.
· Processes all initial enrollment and re-enrollment applications on all PHP, PPS and Palliatie providers as necessary for timely billing of claims.
Collaborative Agreement development and coordination, tracking and monitoring for completion for Physician Services and PruittHealth Premier Providers.
PPS Office Management activities; receives/responds to calls from contractors/partners/patients/families regarding PPS
Collects and reports metrics from various sources (EMR/clinical, Billing/financial, customer service, etc.
Schedules and manages meetings for PPS activities
Assists with addressing or escalating customer service issues and complaints regarding PruittHealth Physician Services or PruittHealth Premier
Establishes administrative procedures and assists with continuous process improvement in operational areas.
Serves as a super user for electronic medical record system and reporting functionality.
As needed for the role; orders uniforms, computers, business cards, cell phones and/or desk phones, and eFax
Administration & processing of FMLA requests
Runs department HR reports utilizing PeopleSoft HRMS to verify employment status
Run license/certification report, verifies licenses and certifications online, and updates PeopleSoft accordingly
Maintains health card record in PeopleSoft
Liaison between partners, Partner Services, and payroll - assists in resolving any issues
Receives PTO slips from managers, maintains PTO schedule, liaison with payroll department to ensure accurate deduction and accrual
Explains and monitors provider CME-related conferences/travel/CME documentation
KNOWLEDGE, SKILLS, ABILITIES:
Communicates well with clients, vendors, partners, visitors and family members providing warm and friendly greeting and an approachable attitude. Answers questions when appropriate in a professional manner.
Demonstrates effective teaching skills
Must be proficient in the use of computers (Microsoft Office, EMR, CVO and Payer enrollment platforms, etc.), phone systems, copiers, fax machines and other various office equipment.
Must be able to demonstrate computer skills, including use of e-mail and Microsoft office suite
Must be able to demonstrate effective written communication skills including but not limited to writing reports and correspondence
Must be able to demonstrate effective verbal communication skills, including but not limited to speaking effectively to members, providers, families and staff and listening to members, providers and families
Demonstrates ability to meet deadlines, and use time effectively and efficiently.
Uses logical methods to solve problems with effective solutions; looks beyond the obvious for solutions
Assists, as needed, in center/agency surveys (Licensure / JCAHO) and any subsequently required reports.
Attends and participates in continuing educational programs to keep abreast of changes in your field as well as to maintain current license/certification, as required.
Attends and participates in mandatory in-services.
Honors patients/residents' rights to fair and equitable treatment, self-determination, individuality, privacy, property and civil rights, including the right to wage complaints.
Complies with corporate compliance program.
Reports job-related functions/tasks that involve occupational hazards.
Follows established safety regulations, to include fire protection & prevention, smoking regulations, infection control, etc.
Follows established safety procedures when performing tasks and/or working with equipment.
MINIMUM EDUCATION REQUIRED:
Bachelor's Degree or its equivalent
MINIMUM EXPERIENCE REQUIRED:
Three (3) years' experience in Health Care management, administrative support or office management
MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:
None
ADDITIONAL QUALIFICATIONS: (Preferred qualifications)
Formal education or training in Healthcare Administration desired. PAHCOM (Professional Association of Health Care Office Management) Certification; preferred. Previous experience with Electronic Medical Record environment strongly preferred. Previous experience with Provider documentation and provider credentialing preferred.
Family Makes Us Stronger. Our family, your family, one family. Committed to loving, giving, and caring. United in making a difference.
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As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.
