Provider Contracting Assistant

2 weeks ago

Grand Rapids, Michigan, United States Health Alliance Plan Full time $40,000 - $70,000 per year

General Summary
Coordinate processing and maintenance of provider contracts and maintenance of provider demographic information including new contracts, terminations and modifications, and configuration of Contract Manager, Facets or its successor systems. As a team member, provide administrative support, coordinate, and prepare appropriate correspondence/contracts/audits for regulatory agencies, network maintenance projects, and strategic initiatives.

Duties & Responsibilities

  • Conduct activities to enroll providers for participation with HAP including pre-screening, preparing, and sending credentialing applications and contracts to providers, coordinating with delegated networks, and maintenance of tracking logs of all provider enrollments.
  • Prepare contracts in the Contract Management System, send contracts to providers, and track contracts through approval process.
  • Prepare Provider Reimbursement Worksheets (PRW's) and or Ancillary Reimbursement Worksheets (ARWs) in accordance with departmental procedures for provider enrollments, terminations, demographic changes or other modifications.
  • Assist department with all Single Case Agreements, regulatory reporting and audits, and special projects as needed.
  • Resolve provider enrollment and provider inquiries in assigned Pega workbasket. Maintain caseload in Pega workbasket and email boxes on a regular basis.
  • Assist department staff with telephone triage, field provider calls and direct as appropriate, assist internal departments with provider inquiries and reimbursement verification.
  • Assist and participate in the interpretation, summarization, communication, and recommendation on key elements of provider contracts to the appropriate individuals both internal and external to the organization.
  • Assist and participate in timely triage and resolution of provider issues.
  • Assist and assume responsibility for focused projects within the department relating to provider contracting.
  • Perform other related duties as assigned.

HAP Pay Grade: 18 (non-exempt)

Education/Experience Requirements

  • High School Diploma required.
  • Two (2) years of college with courses in business, or computer related program preferred.
  • Minimum of two (2) years of health care experience required.
  • Minimum of two (2) years of Provider Relations/Provider Contracting experience.
  • Strong working knowledge of computer systems and personal computers.
  • Knowledge and experience of a managed care organization's operations are required.
  • Knowledge of physician reimbursement methodologies is preferred.
  • Analytical and problem-solving skills.
  • Must possess organizational and time management skills.
  • Self, motivated with effective communication and interpersonal skills.
  • Knowledge of HAP's provider system preferred.
  • Knowledge of Excel and Microsoft Word.

Additional Information

  • Organization: HAP (Health Alliance Plan)
  • Department: Provider Contracting
  • Shift: Day Job
  • Union Code: Office/Non-Exempt, HAP

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