Plan Design Specialist jobs in San Bernardino, CA

Description

Job Summary:

The Health Plan Enrollment and Liaison Specialist is responsible for managing the process of provider enrollment for our organization, ensuring that our providers are properly enrolled with our insurance networks. This position provides administrative leadership support to providers and a variety of tasks related to oversight of all payer contract coordination activities including but not limited to maintenance of payer contracts provider rosters, enrollments, notices of provider changes and requests.

Supervisory Responsibilities: N/A

Essential Duties and Responsibilities:

• Works in tandem with the Credentialing Department to ensure timely enrollment of providers with all contracted payers.
• Accurately assist providers in completing the payor enrollment/re-enrollment applications in accordance with payer guidelines, government regulations and standard operating procedures.
• Screen providers completed applications and attach supporting documentation for proper submission to contracted payers for enrollment as a rendering provider.
• Performs extensive follow-up with payers to expedite participation approval to maximize billing opportunities and reduce risk of claim adjustments.
• Timely and accurately maintain detailed enrollment status notes, effective dates, and files in the provider enrollment database.
• Maintains an organized health plan contract information sheet to include but not limited to providers enrollment status and provider re-enrollment dates. 
• Identify emerging issues and communicate with Director of Contracts, Licensing and Credentialing with recommendations for resolution.
• Works with Revenue Cycle Team to resolve credentialing issues with contracted payers and maintain a shared enrollment status database.
• If applicable, assist providers needs relating to hospital privilege.
• Ensure effective communication with both internal and external stakeholders.
• Works independently within scope of responsibility and authority. Understands and follows rigorous State and payer requirements.
• Accountable for meeting or exceeding departmental payor enrollment performance standards and time sensitive deadlines as defined.
• Adheres to departmental policies and procedures.
• Performs other duties as assigned.

Credentialing Duties/Responsibilities:

• As needed this position will serve as a backup credentialing coordinator.
• Provide initial and recredentialing application links through DAP’s credentialing system to identified licensed personnel.
• Performs evaluation of licensed personnel credentialing application and support documents for completeness.
• Monitor and report expiring licensure, board/professional certifications and other expirable documents for all licensed personnel.
• Shared responsibility for reviewing, processing, and distributing incoming correspondence.
• Performs other credentialing duties as assigned.

Qualifications

Qualifications:

Minimum Qualifications (Education and Experience):

• Two years medical front office experience
• Knowledge of health plan structure and insurance

Knowledge, Skills, and Abilities:

• Strong analytical and problem-solving skills.
• Ability to organize and prioritize job tasks and requirements.
• Ability to effectively perform in a multi-task work environment.
• Strong communication and interpersonal skills.
• Ability to effectively use oral and written communication skills with clinicians, external agencies, and management in a courteous and professional manner.
• Knowledge and skills in using computers (Windows operating system) with a strong emphasis on Microsoft Office Programs-Outlook, Word, Excel and Adobe Acrobat or other related PDF programs.
• Ability to maintain confidentiality.
• Ability to exhibit a commitment to teamwork, supporting alignment with company and department goals, objectives and assisting others to develop their knowledge of the company, department and adapting to changes in a positive manner.