Provider Relations and Contract Operations Associate, 30hrs

Job description

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. Independently maintains and updates the Highland Healthcare Associates IPA (IPA) Physician Information Database (Database) with demographic, contracted health plan, EMR, and other physician and practice specific data. Makes recommendations for the addition or revision of database fields and reports to enhance the existing Database resources. Assures accuracy and integrity of Database and physician roster information. Enrolls and terminates physicians in the contracted health plans. Compiles, reviews, and submits physician rosters to contracted health plans, Physician Contracting Network, and internal staff. Participates on various IPA committees and work groups. Provides special projects support to Provider Relations and Contract Operations Manager and Specialists. Job Description: QUALIFICATIONS Education Required: Directly relevant experience can be considered in lieu of degree. Preferred: Bachelor’s Degree preferred; additional directly relevant experience can be considered in lieu of degree. Experience Required: At least three years of previous administrative experience. Preferred: Experience in a healthcare setting strongly preferred. Experience with Salesforce or other CRM application beneficial. Other Skills/Knowledge Required: Strong interpersonal, communication, and organizational skills required. Excellent Microsoft Office skills required. Ability and willingness to learn Salesforce CRM and other software programs. Ability to work independently and with teams, work with time sensitive targets, respect for confidential nature of information, tact in dealing with sensitive issues, and flexibility. LICENSES, REGISTRATIONS, and CERTIFICATIONS: None required. LIFE SUPPORT CERTIFICATION REQUIRED: None required. POPULATION SPECIFIC REQUIREMENTS : Not applicable. OTHER JOB REQUIREMENTS: On-call Requirement: Not applicable. Schedule Requirements: Not applicable. Travel Requirements: Not applicable. REPORTING RELATIONSHIPS: Reports to Manager of Provider Relations and Contract Operations Not responsible for supervising the work of others. JOB FUNCTIONS Consistent with the PROMISE principles and inherent in a hospital environment, employees must be flexible in meeting patients’ and the Hospital’s needs. While the list below describes the primary functions of this job, all employees at Winchester Hospital need to recognize that an essential element of their job is the ability to respond to unanticipated and/or changing situations. This may result in assuming responsibilities or tasks, which are not on this list. As part of the Highland Health team, this position: 1. Maintains and updates the fields within the Database, assuring the accuracy and integrity of current physician and practice demographics, EMR, health plan, and other IPA and Network information. 2. Serves as subject matter expert as regards to Database content. Keeps appropriate IPA and Highland Management staff current on new physicians, physicians leaving the IPA, and physician and practice status changes. Produces database reports for internal and external customers. Educates other IPA staff on new database features and reports, as applicable. Provides regular physician demographic and health plan rosters to Network and contracted health plans, ensuring accuracy of each health plan’s data. 3. Makes recommendations for development of new database fields, reports, and other enhancements to meet and streamline health plan and IPA operations. Interacts with IPA staff and CRM vendor to implement database revisions and enhancements. 4. Posts website content, as requested. Ensures accuracy and integrity of website-based physician directories. 5. Supports Provider Relations and Contract Operations Specialist with enrolling physicians in the health plans under contract with the IPA and Network, including but not limited to distribution and collection of enrollment materials, interacting with the physicians and/or office staff and health plan credentialing staff, tracking enrollment, tracking IPA membership fees, and reviewing the accuracy of materials submitted to health plans and Network. Assists physicians and practice staff with completing physician termination notifications and status changes to ensure the integrity of communications to the health plans. 6. Provides support with physician enrollment functions for new IPA-Network health plan contracts. 7. Serves as a physician enrollment resource for the following: Credentialing Department of each contracted health plan, pertinent Winchester Hospital departments and IPA and Network staff. 8. Prepares for and coordinates key organizational meetings including: quarterly New Physician Orientation Meetings, Annual Practice Manager Meetings, Annual Physician Membership Meetings, and other meetings as assigned. 9. Serves as back-up resource to other Provider Relations and Contract Operations staff, as needed, by responding to phone calls and e-mail correspondence from physicians and their practice staff. Runs fee reports on a back-up basis, as needed. 10. Participates in special projects at the direction of Manager and/or Director. 11. Participates in the following: a. Mandatory training requirements as per hospital/unit policies b. Continuing education/inservices to enhance knowledge c. Staff meetings and other applicable department meetings d. Performance improvement initiatives e. Orientation of new staff, students, and/or volunteers Pay Range: $26.44 - $43.27 The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law. As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment. More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger. Equal Opportunity Employer/Veterans/Disabled