DEPARTMENT: Provider Relations / Credentialing
REPORT TO: Manager, Revenue Cycle management
STATUS: Exempt
UNION AFFILIATION: None
SCHEDULE: Full Time

JOB OVERVIEW:
Responsible for daily management of the PHP Provider Relations staff and the processes, workflow and controls associated with provider enrollment.

1. Serves as liaison between PHP Administration, payors, & physicians.
2. Provides efficient and centralized enrollment for PHP providers.
3. Serves as a resource for internal and external customers regarding credentialing and enrollment procedures.
4. Works closely with PHP Administration, providing regular payor/ provider enrollment status reports.
5. Works with representatives from various hospitals with whom PHP physicians practice.
6. Serves as main point of contact for physicians to streamline credentialing and ensure physicians are productive and are able to practice and bill on day one.
7. Interviews, hires, trains, plans/ directs/ supervises the work of, evaluates the performance of, and when necessary, disciplines and discharges department personnel.
8. Establishes and maintains productivity standards and an effective workflow process for Provider Relations staff.
9. Works with payor provider relations staff to resolve problems.
10. Works to implement a computer-based provider management system for enrollment.
11. Practices evidence-based decision making.
12. Fosters a success-oriented, accountable environment

ESSENTIAL FUNCTIONS:
1. Accountable for development of department policy and ensuring procedures and communications.
2. Accountable for fair and consistent interpretation and application of policy across the department.
3. Accountable for outcomes and results of the department.
4. Accountable for alignment and achievement of PHP corporate priorities.

SKILLS REQUIRED:
1. Working knowledge of NCQA’s payor credentialing rules and regulations, as well as billing rules and regulations of third party payors.
2. Working knowledge of JCAHO hospital credentialing standards.
3. Extensive knowledge and experience with Medicare provider enrollment applications and processes.
4. Solid PC skills, specifically MS Word and Excel.
5. Cactus and NextGen software proficiency a plus.

EXPERIENCE REQUIRED:
Previous experience in physician revenue experience necessary.

EDUCATION REQUIREMENTS:
BS/ BA and five + years experience in provider/payor management.