Provider Relations Internal Project Coordinator

ADVANTAGE Health Solutions, Inc. has an opening for a Provider Relations Internal Project Coordinator

 

Duties include, but are not limited to:

 

 

Responsibilities:

 Responsible for Credentialing of Individual Providers contracting with ADVANTAGE.  Preparation of file, communicating with provider for necessary information checking relevant websites for required file information, meeting required deadlines, and preparation of file for the Credentialing Committee;Act as Project Lead for NCQA and HEDIS Preparation.  Communicate with Q.I. Manager regarding any needed information from Provider Relations Department and/or contracted Provider Networks to ensure all deadlines are met;Responsible for initial research and documentation of individual provider appeals directed to the Provider Relations Department.  Documentation will be presented to the Provider Relations Manager, to determine appropriate resolution.  Assume lead role in coding documentation properly and generate management reports to identify trends and opportunities for service improvement.Responsible for intake of all claims pended to Provider Relations Department (either through QNXT Call Tracking or other entry points).  Performs investigation and resolution of pended claims, and engages the Provider Relation Specialist or Manager as appropriate for complex issues.  Must ensure timely processing consistent with policies and procedure.  Document all issues properly and generate management reports to identify trends and opportunities for service improvement;Responsible for all Medicare Recovery cases directed to the Provider Relations Department.  Able to work with the Provider Networks to collect all the necessary information for timely response to Medicare as per the ADVANTAGE Policy and Procedure;Responsible for coordinating Provider Newsletters.  Will work with the Medical Director and the Provider Relations Manager to coordinate gathering appropriate articles from internal staff, as well as acting as liaison with Printer to ensure meeting required deadlines;Perform related and unrelated responsibilities assigned by management as needed, as well as assistance and general back-up to the Provider Relations Manager and Specialist.

 

 

Requirements

 

Requirements to Quality for Position:  The qualified candidate will have a strong working knowledge performance improvement planning and implementation, and 2-3 years minimum work experience in a like environment required.  Bachelors Degree preferred.  Must have excellent organizational skills, as well as the ability to manage multiple priorities and deadlines.  Must maintain professional appearance with work ethic, and be able to work effecrively with all levels of personnel.