GENERAL SUMMARY:

The purpose of this position is to provide daily support and maintenance of the Provider Network for the Beaumont ACO . This includes but is not limited to inputting changes to the provider network (i.e., additions of new providers, changes in provider addresses, Tax I.D. Numbers, deletions etc, for 5200+ Beaumont ACO providers and Expanded Network providers including ancillary providers.). Works with TPA reps regarding changes to the network as well as working with physician offices regarding enrollment and billing issues.

ESSENTIAL DUTIES:

1. Inputs all provider demographic changes into the Beaumont ACO Provider Database, (i.e., address changes, TIN changes, additions/deletions of providers, ancillary providers etc.) and maintains the Data Base for the online myBEHP App, Provider Directory information.

2. Prepares weekly reports of provider activity and prepares file transfer to the Employee Health Plan for network maintenance.

3. Interfaces with providers' offices regarding inappropriate billing concerns, issues with fee schedule reimbursements, or other office issues.

4. Conducts follow up with contracted payers to ensure enrollment process is completed and providers are notified of effective dates.

5. Constructs and works with the publisher of contracted payers Provider Directories.. Contacts physician offices and ancillary facilities to ensure accuracy of directories. Including accessing required contracted plans online portals to initiate changes.

6. Assists in follow up with contracted providers to ensure data is updated in the CAQH database.

This document represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described.

STANDARD REQUIREMENTS:

1. Supports the Mission, Value and Vision of Corewell Health (CH). Demonstrates personal commitment through active involvement in the performance improvement process.

2. Exhibits excellent customer service skills and behaviors toward internal and external customers and co-workers. Promotes positive public relations with patients/residents, family members, guests, and others.

3. Supports and adheres to all Corewell Health’s customer service, service excellence, and performance standards. Supports and participates with all required compliance standards that may be department specific and/or identified by the organizations including in-service training, acceptable attendance, uniform and dress code.

4. Adheres to HIPAA requirements and maintains confidentiality of all data, including patient/resident, employee and operations information.

5. Supports and participates in a collaborative team-oriented environment – cooperates and works together with all co-workers, plans and completes job duties, uses appropriate communications in sensitive and emotional situations and follows up as appropriate regarding reported complaints, problems and concerns.

6. Supports, cooperates with and demonstrates safe work practices and attitudes, follows safety rules – including universal precautions - reports and prevents/corrects unsafe conditions and behaviors, and participates in organizational and departmental safety programs.

7. Completes all required compliance standards that may be department specific and/or identified by the organization.

8. Maintains current licensure, registration and/or certification, as applicable, at all times.

STANDARD QUALIFICATIONS

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

A. Education / Training:

• Associate degree in business or related field.

B. Work Experience:

• Managed Care experience preferred.

C. Certification, Licensure, Registration:

• N/A

D. Other Qualifications:

• Knowledge of CPT Coding, Health Plan Operations, Fee Schedule Development.

• Knowledge of medical billing practices and reimbursement methodologies.

• Ability to work effectively with others in sometimes difficult circumstances.

• In this position, the successful candidate must have excellent communication and interpersonal skills as the individual is required to interact with the physician offices as the first level of contact for Beaumont ACO providers.

• Beaumont Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.