Provider Engagement Coordinator
2 weeks ago
Position Overview:
The Provider Engagement Coordinator plays a crucial role in fostering and enhancing relationships with healthcare providers through effective communication, support, analysis, problem resolution, and educational initiatives aligned with the objectives of the NIOSH World Trade Center Health Program.
Key Responsibilities:
- Collaborate directly with healthcare providers to ensure they receive comprehensive support and are well-informed about all relevant policies and procedures in a professional and efficient manner.
- Partner with both internal teams and external stakeholders to address the evolving needs of providers and their patients.
- Maintain a detailed database of provider contacts, utilizing various tracking reports to ensure accurate and up-to-date information.
- Build and nurture relationships with Clinical Centers of Excellence (CCEs) to facilitate provider nomination requests, track pursuit statuses, manage prescriber authorizations, and provide ongoing support to members.
Provider Support:
- Address incoming inquiries through the dedicated Provider Enrollment mailbox and manage escalated ServiceNow tickets from the Call Center, focusing on provider requests such as Remittance Advice (RA) statements and claim denial reviews related to enrollment issues.
Grievance Resolution:
- Collaborate with relevant stakeholders to ensure timely resolution of provider grievances, ensuring a smooth experience for all parties involved.
Documentation Management:
- Support the secure exchange and organized management of all provider enrollment documentation, including Terms & Conditions Agreements, EFT, W9 forms, and other related materials.
Compliance Assurance:
- Assist in ensuring that providers adhere to all program requirements as stipulated in their agreements, particularly regarding availability and access standards, while evaluating compliance as necessary.
Education and Guidance:
- Provide education, coaching, and guidance to providers on essential metrics, programs, and quality initiatives to enhance their operational effectiveness.
Provider Experience Management:
- Take full ownership of the provider's recruitment, enrollment, and participation journey, which includes outreach, education, processing agreements, liaising with CCEs as appropriate, and addressing claims status inquiries.
Record Maintenance:
- Ensure that provider records are updated promptly with any requested changes to demographic information or contract status, and that these updates are processed accurately within the system.
Claims Analysis:
- Conduct research and analysis on pended or escalated claims, collaborating with relevant departments and providers to achieve resolutions.
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