General Summary:

Provides administrative services to support the credentialing/paneling of PA and Affiliate providers with managed care companies and the enrollment of those providers with third party payors. Processes credentialing/recredentialing materials and enrollment applications, tracks the credentialing status for all providers, interfaces with managed care companies.  Monitors delays in responses from companies, researching problems that impact enrollment. Interfaces with Program Directors, Affiliate Directors and Administrators regarding the enrollment process and status of providers. Establishes and maintains database of credentialing status and enrollment provider/rendering numbers.   Develops guidelines, instructions and the like to assist providers, providing articles for the Managed Care Minute and PA Pointers mailings as needed.  Collects data, prepares reports, and provides administrative support for program development.  Provides assistance with Sheppard Pratt’s credentialing as needed.

Knowledge, Skills, and Abilities Required:

Work requires written and oral communication skills, the ability to compose correspondence, comprehensive knowledge of behavioral health billing requirements, and strong computer skills in Excel and Word - acquired through high school education and two to three years of administrative work experience. Bachelor’s degree and prior healthcare experience are preferred. Work requires interpersonal skills sufficient to communicate effectively with P.A. clinicians, Division Directors, contracted clinicians, members of the insurance/managed care community, and other internal staff (21%-50% of work time). Work requires proven project/program and problem-solving administrative skills using Word, Excel, ECHO, and IDX. Work requires proficiency with ECHO database to effectively record information and produce reports according to managed care specifications.