Job Description

Job Description

All the benefits and perks you need for you and your family:

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Benefits from Day One

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Career Development

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Whole Person Wellbeing Resources

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Mental Health Resources and Support

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Our promise to you:

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Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

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Shift : Monday- Friday Full time 8am-5pm

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Job Location : Remote

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The role you will contribute:

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Responsible for credentialing systems including applications and credentialing for various ancillary groups and specialties for which contracting services are provided. Maintains and updates all credentialing systems with current information. Responsible for coordinating and maintaining all credentialing documents necessary to complete credentialing and re-credentialing of all ancillary groups for which we contract. Maintains a working knowledge of the statues and laws relating to credentialing as well as applicable contract agreement requirements. Responsible for auditing and data analysis for all physician/provider credentialing records, documents, and files. Responsible for programming Network Management applications to generate reports necessary to ensure accuracy of data. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

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The value you will bring to the team:

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• Responsible for the credentialing efforts for Ancillary facilities
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• Ensures credentialing information is complete based on the requirements of the specific provider type
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• Responsible for understanding and utilizing the functionality of Network Management (or any subsequent credentialing database) and training new employees.
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• Responsible for processing ancillary applications within Network Management (or any subsequent credentialing database) and works.to ensure information is complete, accurate, and up to date.
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• Ensures that credentialing applications are scanned and programmed to populate with physician information and/or Facility.
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• Assists in maintaining a complete database (including CAQH) of all credentialing materials for all employed physicians/providers and/or Facility if applicable.
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• Utilizes advanced level of skill relating to the understanding of payer credentialing nuances and disseminates such information and trains team members as necessary.
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• Tracks re-credentialing and vendor roster requests coming into the department.
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Support

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• Supports the Credentialing Manager and Director of Credentialing, Contracting and Revenue Management by resolving problems, questions, and issues internally, as well as at the payer and the practice.
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• Supports ancillary contracting and operation services by auditing and analyzing data, verifying applications, preparing amendment letters, ensuring ancillary enrollment materials are processed efficiently, professionally, and as expeditious as possible.
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• Researches any inconsistencies or discrepancies as assigned by leadership and educates entire team of findings.
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• Supports the Negotiators through notification of current application status and new contract requirements.
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• Supports the overall mission of AdventHealth and the role of the Managed Care department in that mission.
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• Supports the contracting team, internal departments, ancillaries, and physician groups, and owned PHOs as applicable, to assist with, identify, and resolve operational, accounts receivable, utilization management, quality assurance, billing, and other related issues.
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The expertise and experiences you'll need to succeed:

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• High School Grad or Equivalent
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• 4 Work Experience
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• Attentive to detail and accuracy; strong organization skills required.
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• Knowledge of related accreditation and certification requirements.
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• Knowledge of medical credentialing and privileging procedures and standards.
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• Database management skills including querying, reporting, and document generation.
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• Typing 35 wpm
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• MS Office (Excel, Word, Outlook)
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Preferred Qualifications:

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• Bachelor's Degree
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• Network Management
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• CAQH, Availity, and/or MD-Staff Experience
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• MSOW/Network Management
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This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

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Category: Managed Care

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Organization: AdventHealth Corporate

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Schedule: Full-time

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Shift: 1 - Day

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Req ID: 25027141

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We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.

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Job Tags

Full time, Work experience placement, Local area, Monday to Friday, Shift work,

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