Payer Provider Specialist

Education:
One year of computer science class, including advanced training in Microsoft Office and other PC-based tools OR Equivalent technical/professional experience
Associate or bachelor's degree or equivalent experience

Licensures/Certifications:
Not Applicable

Experience:
Preferred but not required, one year in a Medical Staff Office or Managed Care Department
Skills:
* Skill in using computers and navigating various databases
* Ability to stay current with payer database requirements and be subject matter expert
* Skill in oral and written communications
* Ability to work quickly, accurately, and independently
* Ability to develop and maintain effective relationships with a variety of contacts

Principal Duties and Responsibilities:
* Processes provider and facility information for Medicare, Medicaid, Medicare Railroad, CAQH and other non-delegated applications. Reviews applications for completeness, entering data, obtaining appropriate signatures, and forwarding completed applications to providers. Follows up with Practice Managers and/or physicians as needed to obtain signatures. Notifies billing office of completed application and provides necessary provider billing numbers and effective dates.
* Monitors and processes Medicare and Medicaid re-validation applications for timely completion, processing, and distribution of processed application.
* Organizational contact and submitter for MIPS using appropriate online portals. Creates ad-hoc rosters of employed providers for Population Health reporting.
* Represents Managed Care Department at on boarding or other operational meetings. Is key contact for disseminating all provider activity related to credentialing. Works closely with providers, medical staff office, service line managers and practice managers to assist with timely on-boarding and processing of providers.
* Reviews documentation for compliance with credentialing requirements. Obtains all credentialing documentation, in correlation with the Medical Staff Office or directly from provider in cases of non-delegation.
* Processes and submits Group or Facility credentialing applications to Medicare and Medicaid. Ensures the entire application is complete and accurate to prevent delay in approval status. Copies, collates, and files applications. Follows up with insurance companies to obtain missing information.
* Maintains working knowledge of Medicare, Medicaid, and CAQH credentialing policies, procedures and on-line credentialing tools. Including CMS portals such as NPPES, PECOS, and I&A.
* Develops and maintains proficiency with internal tools such as ECHO, EPIC, and Marketware.
* Assist with payer credentialing issues, as necessary.

All roles must demonstrate GBMC Values:

Respect

I will treat everyone with courtesy. I will foster a healing environment.

• Treats others with fairness, kindness, and respect for personal dignity and privacy

• Listens and responds appropriately to others' needs, feelings, and capabilities

Excellence

I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.

• Meets and/or exceeds customer expectations
• Actively pursues learning and self-development
• Pays attention to detail; follows through

Accountability

I will be professional in the way I act, look and speak. I will take ownership to solve problems.

• Sets a positive, professional example for others
• Takes ownership of problems and does what is needed to solve them
• Appropriately plans and utilizes required resources for various job duties
• Reports to work regularly and on time

Teamwork

I will be engaged and collaborative. I will keep people informed.

• Works cooperatively and collaboratively with others for the success of the team
• Addresses and resolves conflict in a positive way
• Seeks out the ideas of others to reach the best solutions
• Acknowledges and celebrates the contribution of others

Ethical Behavior

I will always act with honesty and integrity. I will protect the patient.

• Demonstrates honesty, integrity and good judgment
• Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers

Results

I will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals.

• Embraces change and improvement in the work environment
• Continuously seeks to improve the quality of products/services
• Displays flexibility in dealing with new situations or obstacles
• Achieves results on time by focusing on priorities and manages time efficiently

Pay Range

Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.

COVID-19 Vaccination

All applicants must be fully vaccinated against Covid-19 or obtain a GBMC approved medical or religious exemption prior to starting employment at GBMC Healthcare, to include Gilchrist and GBMC Health Partners.

Equal Employment Opportunity

GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.