Company :Highmark Inc.Job Description :Job SummaryResponsible for supporting provider account activities with the implementation and administration of provider demographic information, Credentialing, and Credentialing Compliance. This position identifies and resolves problems related to provider file set up, provider affiliations, reporting, data inputs/outputs, and any subsequent requirements. May have direct interaction with providers, provider offices, billing agents, provider representatives, management, and other internal staff. The position will ensure compliance with the National Committee on Quality Assurance (NCQA), CMS, DOH Regulations, BCBS, and internal/private business audits in the provider data management space.This is a bargaining unit position. The collective bargaining agreement for this position requires that candidates and employees reside in the following counties in the State of New York: Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans, or Wyoming.Duties Note: The following is not intended to be an exhaustive list of all duties required of this position.
Verifies confidential information via subscription web sites as needed for completing the credentialing and re-credentialing process: Performs necessary queries and background checks required by regulatory agencies by accessing various agency data banks and web sites; Ensures information is appropriately tracked in system; Reviews application and information to determine if Level I, II, II based on specific level criteria; and Performs primary source verification of provider information from reports (e.g. DEA quarterly report)
Facilitates the process for the assignment of the Council for Affordable Quality Healthcare (CAQH) as part of the credentialing process, on behalf of the provider
Reviews provider and facility enrollment applications and certifications to obtain missing information or verification according to regulatory requirements: Contacts providers through email, phone or written correspondence utilizing template.
Responds to identified outstanding provider and facility credentialing issues and assists in resolution: answers internal and external inquires of application status via phone and/or written correspondence; and communicates with providers regarding any step or stage of the application process.
Prepares materials for Credentials Committee for application review, prepares data tracking reports by entering required data, assembles materials necessary for committee meetings, and ensures all applicable applications are available for review by the Medical Director.
Interact with all levels of management to achieve company-wide goals and compliance deadlines.
Performs all job duties efficiently, accurately and at an acceptable rate of performance.
Performs related clerical duties
Maintains confidentiality and adheres to HIPAA regulations.
Delivers customer service in a professional, polite and efficient manner.
Performs other duties of a similar nature that are necessary and not inconsistent with this position or pay grade.
Education/Experience/Skills RequirementsRequired Education:HS/GED:Required Experience:
Minimum of one (1) to two (2) years experience in an administrative position with deadlines or productivity/quality metric requirements.
Preferred Experience:
One (1) or more years’ experience in a healthcare administrative support role.
Credentialing certification from a nationally recognized organization.
Required Knowledge/Skills:
Must meet qualifications to perform the job including satisfactory completion of all training and testing.
Data Entry 9,000 KPH.
Correspondence test.
Service Representative Test
Ability to self direct and multitask in fast paced service environment while meeting department metrics. Ability to work collaboratively as a team.
Well organized with ability to adapt to changing office environment; exhibits attention to details and time management skills.
Proficiency in English language skills, including spelling, punctuation and grammar, in both written and verbal communication to ensure communications are issued in a professional manner.
Ability to effectively communicate (verbal, written and interpersonal communication) with internal and external contacts, in a professional manner.
Working knowledge of personal computer and application software such as Microsoft Office
Ability to utilize basic office equipment.
Ability to efficiently navigate multiple computer screens and programs simultaneously.
Must display and demonstrate Core Values and adherence to Company Office Rules.
Maintains confidentiality and adheres to HIPPA regulations
Required Licenses/Certifications:
None
Preferred Licenses/Certifications:
None
Managerial/Supervisory ResponsibilitiesDoes this Position have Supervisory Responsibility? NoNumber of Emps Supervised:Titles of Employees Supervised:Financial/Budgetary Responsibilities:Other Job Specifications:External Contacts: Customers, Providers, Groups, other insurance plansWorking Conditions/Physical Demands:Position requires:
Must be able to work in an office environment
Position involves:
Physical Effort: Minimum; typical of most office work. Mostly sedentary work.
Weight: lift/carry/push/pull under 10 lbs.
Prolonged Sitting
Repetitive Motion
Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively utilize various office equipment (phone, computer, fax machine, printer, copier, filing cabinet, etc)
Manual Dexterity Req: Eye-hand coordination and manual dexterity sufficient to effectively use a computer with all its components for prolonged periods of time and for the majority of required tasks
Vision Req: Close vision (clear vision at 20 inches or less
Pay Rate:The starting hourly rate for this position listed above is for new employees. This rate has been established by the Local 153, Office and Professional Employee International Union (OPEIU) collective bargaining agreement (CBA) and is non-negotiable. If the successful candidate is currently a bargaining unit member of the OPEIU, hourly rate is commensurate with their anniversary year and pay grade as per the CBA.Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.For accommodation requests, please contact HR Services Online at [email protected] Consumer Privacy Act Employees, Contractors, and Applicants NoticeReq ID: J261970