Coordinator

GENERAL SUMMARY:

Under minimal supervision, works specifically with Patient Financial Services (PFS) Directors,PFS Managers and Revenue Team Managers to interpret third party billing and reimbursement regulations concentrating on their overall impact on the Provider Plan Enrollment (PPE) and Patient Financial Services operations. Initiates communication with Patient Financial Services staff in order to monitor and resolve third party billing and compliance issues. Identifies system problems and implements corrective action, which is an integral part of insuring appropriate cash flow. Act as liaison and support staff for the Council for Affordable Quality Healthcare (CAQH) initiative. Working with Administrators, Providers and Office Staff to ensure compliance with CAQH requirements and mandates by third party groups Performs special projects while taking an active role as a departmental liaison in the implementation of policies and procedures that affect Patient Financial Services and external clients.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• Meets and confers with third party financial personnel regarding billing issues as they relate to the Provider Plan Enrollment systems.
• Coordinates provider files which are an integral player in provider billing and reimbursement.
• May be the hospital representative at external meetings which involve HFH management or employer groups.
• Ensures compliance with all third parties for the registration of staff physicians.
• Responsible for the review and submission of all provider enrollment documents to Medicaid, Blue Cross Blue Shield, Medicare and other third party payors for all contracted physicians on staff.
• Determines appropriate specialty assignment for maximum reimbursement and accurately maintains professional and hospital physician master files.
• Fields incoming calls for information from numerous external and internal sites regarding provider enrollment issues.
• Monitors rejections to determine if any profiles or master files can be updated to expedite payments and enhance either reimbursement levels or the automation process of A/R claims.
• Analyzes and resolves user problems associated with system use from all insurance receivables to help resolve internal and external billing issues.
• Ability to work in all phases of provider enrollment, ensuring the timely and accurate enrollment of providers with various payers and government agencies.
• Knowledge of provider enrollment/contracting & credentialing policies and procedures.
• Call providers to disseminate time-sensitive information.
• Research provider issues related to enrollment with payers, Medicaid, Medicare, etc.
• Track, monitor and follow-up with providers to ensure timely submission of CAQH attestation every 120 days.
• Update credentialing database with new provider changes in CAQH.
• Monitor submitted provider enrollment applications to ensure provider information is received within payers’ standards. Follow-up with payers on issues or questions related to enrollment submissions.
• Work with payers, providers and PFS to resolve payers’ questions and issues.
• Performs other duties as assigned.

EDUCATION / EXPERIENCE REQUIRED:

• Bachelor’s Degree OR equivalent combination of education and experience in Computer Science, Business, Healthcare or other related area.
• Minimum 3 – 4 years of provider enrollment, contracting and/or credentialing experience within a healthcare setting – preferably hospital or managed care environments.
• Billing or reimbursement experience desired.
• Able to interact with providers and/staff to provide appropriate and timely response to inquiries and concerns regarding provider enrollment.
• Proficiency in Microsoft Office.
• Knowledge of Visual Cactus credentialing software or an electronic credentialing system is preferred but not required.
• Knowledge of CAQH Database

Overview
Henry Ford Health System, one of the largest and most comprehensive integrated U.S. health

care systems, is a national leader in clinical care, research and education. The system includes

the 1,200-member Henry Ford Medical Group, five hospitals, Health Alliance Plan (a health

insurance and wellness company), Henry Ford Physician Network, a 150-site ambulatory

network and many other health-related entities throughout southeast Michigan, providing a

full continuum of care. In 2015, Henry Ford provided $299 million in uncompensated care.

The health system also is a major economic driver in Michigan and employs more than 24,600

employees. Henry Ford is a 2011Malcolm Baldrige National Quality Award recipient. The

health system is led by President and CEO Wright Lassiter III. To learn more, visit HenryFord.com .

Benefits
Whether it’s offering a new medical option, helping you make healthier lifestyle choices or

making the employee enrollment selection experience easier, it’s all about choice. Henry

Ford Health System has a new approach for its employee benefits program – My Choice

Rewards. My Choice Rewards is a program as diverse as the people it serves. There are

dozens of options for all of our employees including compensation, benefits, work/life balance

and learning – options that enhance your career and add value to your personal life. As an

employee you are provided access to Retirement Programs, an Employee Assistance Program

(Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness

and access to day care services at Bright Horizons Midtown Detroit, and a whole host of other

benefits and services.

Equal Employment Opportunity/Affirmative Action Employer
Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health System is

committed to the hiring, advancement and fair treatment of all individuals without regard to

race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height,

weight, marital status, family status, gender identity, sexual orientation, and genetic information,

or any other protected status in accordance with applicable federal and state laws.