Provider Enrollment Liaison |
| Location: | Indianapolis, IN |
| Exempt/Non-Exempt: | Non-Exempt |
| Benefits: | yes |
| Type: | Full Time |
| Department: | Executive |
| Description: | This position will manage and coordinate the relationship between IUMG-PC, providers, and various delegated commercial insurers. This includes the submittal of new provider profiles for insurers to use to load providers for billing purposes and updates to provider directories. This position will work internally with IUMG-PC departments and practices to communicate the billing rules and requirements of those insurers. This position will act as a credentialing liaison between new IUMG-PC providers and the Wishard and Clarian Medical Staff Offices and the Indiana Clinic Credentialing Committee to ensure that all provider applications are complete with all required attachments included prior to submittal for credentialing. Responsible for obtaining, tracking, recording, and validating daily provider activities for outpatient ambulatory providers.
This position is located in the administrative office located at 8910 Purdue Rd on the north west side of Indianapolis. |
| Duties: | ESSENTIAL FUNCTIONS:
• Interacts with all internal and external customers in a caring and respectful manner in accordance with our Core Values philosophy.
• Acts as the IUMG-PC Liaison with providers, contracted insurance companies; Indiana Clinic contracting and credentialing departments; and affiliated hospital medical staff offices.
• Obtains, compiles, and submits the required credentialing documentation to the appropriate organizations. Assists with the resolution of any provider set-up issues.
• Communicates new or updated information from payers to Sites and Departments.
• Reviews insurance provider directories to assure accuracy of medical group providers. Submits updates as needed to correct or revise information.
• Coordinates efforts of process improvement, refinement and management in the ongoing and recurring processes with payers.
• Helps to resolve patient related provider set-up issues.
• Obtains and communicates payer specific fee schedule when requested.
• Maintains outpatient ambulatory provider activity database.
• Tracks Clinical Schedule by practice location to include: Vacation, Continuing Medical Education, Sick, Introduction to Clinical Medicine, provider time leased to external organizations, education, research, etc.
• Maintains protected health information in accordance with HIPAA privacy guidelines.
• Maintains confidentiality of patient and provider information.
ADDITIONAL RESPONSIBILITIES:
• Participates in professional development activities to keep current with health care trends.
• Performs other duties as assigned.
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| Qualifications: | KNOWLEDGE, SKILLS, AND ABILITIES:
• Knowledge of physician credentialing process.
• Knowledge of medical health insurance plans and contracts.
• Extensive knowledge of and experience using personal computers in a Windows environment.
• Knowledge and understanding of medical billing codes, medical office terminology and familiarity with clinical information systems.
• Knowledge of medical claim processing processes
• Excellent written, verbal, and interpersonal communication skills.
• Communication skills necessary to deal courteously and clearly with internal and external customers.
• Ability to teach and train others.
• Ability to plan, analyze, problem-solve, organize, and prioritize work.
MINIMUM QUALIFICATIONS, TRAINING, AND EXPERIENCE:
• High School Degree or GED.
• Two years experience in one of the following areas or a combination of:
• The health care industry including knowledge of health insurance
• Medical office billing processes or medical office business operations
• Medical Claims Processing
• Provider Relations
• Two years experience working with physician credentialing process preferred.
• Must be able to type 30 AWPM
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