Provider Professional Services Administrator - Springfield, MA

SUMMARY

The Provider Professional Services Coordinator. Is responsible for coordination of Physician Training and Billing related Activity to Bill and Code for optimal reimbursement, eCR Documentation of appropriate levels of E&M Levels Visits and Adjunct coding, Practice Demographics, Paysource Entry and Authorizations, Additional responsibilities include Payer Credentialing and Special Projects as needed.

ESSENTIAL DUTIES AND RESPONSIBILITIES

· Tracks Targets for Optimal Reimbursements of Provider's Productivity.

· Conducts Trainings at the Direction of Billing Director, Topics to Vary

· Conducts and Supports, Provider Audits both Targeted and Baselines as Outlined In Compliance Plan

· Maintains fee schedules and Paysource data in EHR system for the carriers

· Generates Productivity Reports, and Claims by CPT and Reports to Billing Director

· Weekly, run and review violation reports and work with clinical and medical staff to resolve errors

· Prepare end of month billing reports sent to finance to record revenue

· Perform Credentialing Duties Assigned

CREDENTIALING RESPONSIBILITIES

  • Compiles and maintains current and accurate data for all providers.
  • Completes provider credentialing and recredentialing applications; monitors applications
  • and follows-up as needed.
  • Maintains copies of current state licenses, DEA certificates, malpractice coverage and
  • any other required credentialing documents for all providers.
  • Maintains corporate provider contract files.
  • Maintains knowledge of current health plan and agency requirements for credentialing
  • providers.
  • Sets up and maintains provider information in online credentialing databases and system.
  • Tracks license and certification expirations for all providers to ensure timely renewals.
  • Ensures practice addresses are current with health plans, agencies and other entities.
  • Processes applications for appointment and reappointment of privileges to The MD and NPPS Providers
  • Tracks license, DEA and professional liability expirations for appointed ASC providers.
  • Maintains ASC appointment files, and information in credentialing database.
  • Audits health plan directories for current and accurate provider information.

COMPETENCIES

· Knowledge of E&M and Physician Coding and Documentation Requirements

· Ability to Conduct Training in an Organized and Effective Manner to Result in Improvements of Documentation with Provider Level Providers.

· Strong problem-solving skills, documentation skills, research and resolution skills, and data analysis skills

· Ability to communicate effectively verbally and in writing

· Ability to use CAQH System, Pecos, NPPS and Other Online Applications, Medicaid and Medicare Portals, DXC Technology.

· Maintain Relations and Contacts with Payers and needed.

· Conduct Follow-up and Status Request

· Furnish Speedy Response to Rapidly Changing Credentialing Request.

· Implement and Maintain Tracking of Status

· Ability to interact with Management, Providers, Insurance Payers in a professional manner.

· Ability to speak and write English fluently

· Ability to work independently and with a team in a fast-paced and high volume environment with emphasis on accuracy and timeliness

· Ensures client confidentiality in accordance with all federal, state, and local laws and regulations.

· Ability to promote and demonstrate Phoenix House's ICARE4 core values (Integrity, Collaboration, Accountability, Respect, Excellence, Forward Thinking) through work ethic, compliance, and attitude:

- Trustworthiness

- Morale

- Willingness to Help

- Optimism

- Knowledge

QUALIFICATIONS

To perform this position successfully, you must be able to perform each essential duty and responsibility satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties and responsibilities. The requirements listed below are representative of the knowledge, skill and/or ability required.

  • Thorough knowledge obtained through completion of an Associate's degree of an accredited institution or similar course accreditation and at least three years of commercial insurance experience.
  • Proficiency in electronic record systems
  • Ability to comply with internal, local, state, and federal regulations and policies.
  • Ability to work and effectively communicate with others.
  • Ability to demonstrate competency in using computers.
  • Knowledge of state and federal confidentiality laws (HIPAA and 42 C.F.R., contract management, and program administration regulations).

EDUCATION/EXPERIENCE

  • Associates Degree from an accredited institution and three years billing experience, or equivalent combination of knowledge and experience.

LICENSES/CERTIFICATIONS

  • Certified Professional Coder (CPC) or working towards Certification, Certification in Credentialing desired. Certification/Licensure: Certified Provider Credentialing Specialist (CPCS) preferred.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential duties and responsibilities of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties and responsibilities.

  • Travel to Springfield Office as needed for Team Meeting and/or Onsite Supervision.
  • Travel to Provider location as needed for training and coordination.
  • Remote connections required.

REGULARLY REQUIRED: to sit, use hands to finger, handle or feel objects, tools or controls; reach with hands and arms, and talk or hear.

OCCASIONALLY REQUIRED: to stand, walk, stoop, kneel or crouch and lift and/or move up to 10 pounds

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential duties and responsibilities of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential duties and responsibilities.

  • The work environment includes both a typical office environment, with minimal exposure to excessive noise or adverse environmental issues.
  • When at facilities the work environment is that of a substance use disorder and co-occurring treatment milieu which may include:
  • Exposure to patients infected with Hepatitis B, HIV, TB, or other Infectious Diseases
  • Exposure to patients with co-occurring mental health issues.
  • Business-related travel

SCHEDULING NEEDS

Monday-Friday 8-5

Phoenix House requires background checks, drug testing, TB testing, verification of employment history, reference checks and possibly a medical exam, prior to employment.

Phoenix House is an Equal Opportunity Employer providing equality of opportunity to all who are protected against discrimination by law, regulation or executive order, including veterans and individuals with disabilities. EEO is the Law: Applicants and employees are protected under Federal law from discrimination. Click www.dol.gov/ofccp/regs/compliance/posters/pdf/eeopost.pdf to learn more.