Summary of Position:
As a Provider Relations Coordinator at Carisk Imaging, you will provide day-to-day administrative and credentialing support for Carisk’s specialty network of imaging and neurology providers. This role maintains demographic, credentialing and contractual data for participating providers and also ensures all information is accurately recorded and maintained. Additionally, this role provides frontline support for the Carisk billing team and serves as an administrative liaison for both internal and external provider inquiries.
Duties and Responsibilities:
- Accurately enters, maintains and updates information in Carisk’s provider database and operating systems. Diligently manages demographic and contract-related provider data on an ongoing basis and conducts periodic audits of information to maintain accuracy.
- Provides coordination and completion of credentialing and recredentialing activities for new and participating physicians, such as:
- Reviews physician and facility applications, supporting documents and verifies credentials with primary sources.
- Monitors current state licenses, DEA certificates, malpractice coverage, facility licenses, ACR accreditations and other required credentialing documents.
- Follows up with providers when data is incomplete through communication with provider office staff, academic entities and/or other health related entities.
- Releases correspondence to new and existing providers as needed (welcome letters, amendments, billing guides, etc.).
- Electronically stores and maintains provider files and corresponding documentation.
- Responds to internal and external inquiries, including but not limited to:
- Client inquiries (regarding providers’ credentialing or participation status).
- Provider inquiries (such as demographic updates, recredentialing, requests for information, etc.).
- Interdepartmental assistance with network inquiries and provider issue resolution as needed.
- Escalates issues for resolution as appropriate.
- Creates and maintains contractual rates and demographic information for providers, as well as federal and/or state-mandated fee schedules for Medicare, Workers’ Comp and Auto/No Fault.
- Answers reimbursement related inquiries regarding interpretation of provider rates.
- Answers incoming phone calls and correspondence from providers, identifies the type of assistance needed (demographic updates, billing, scheduling, etc.) and addresses the issue when relevant or forwards to the appropriate area for proper handling and resolution.
- Communicates effectively, delivers information and answers questions in a positive manner to facilitate productive relationships with providers and their staff. Ensures professionalism is maintained in all provider interactions and communicates effectively, both verbally and in writing.
- Distributes network-wide communication on a monthly basis, i.e., fax blasts of carrier lists, provider rosters, etc.
- Assists Billing Department by gathering missing information for proper claims processing such as missing provider license information, demographic updates, certification numbers, etc.
- Identifies operational and process short-falls and offers suggestions for remediation. Refers complex provider inquiries and operational issues to management.
- Ensures all work is completed in a timely manner and meets expectations as required for productivity and quality.
- Special projects as needed.
Qualifications:
- Associates or Bachelor’s degree. Significant industry experience will be considered in lieu of a degree.
- Familiarity with healthcare sector, industry terms and/or credentialing systems a plus.
- Certified Provider Credentialing Specialist (CPCS) a plus.
Knowledge, Skills, and Abilities:
- Advanced organizational and prioritization skills required; meticulous attention to detail.
- Capable of managing deadlines and working independently on daily assignments.
- Previous data entry or credentialing experience is required.
- Willingness to be trained and coached as needed.
- Demonstrated ability to listen skillfully, collect relevant information, build rapport and respond to providers and coworkers in a professional and timely manner.
- Strong communication and interpersonal skills with the ability to work collaboratively as a positive team member.
- Excellent verbal and written communication skills.
- Excellent attendance and punctuality.
- Ability to effectively communicate in a professional manner.
- Ability to be flexible, respectful, and calm.
- Must be computer and internet literate; proficiency in Microsoft Office.
- Other duties as assigned.