Job Information
Aultcare Corp. PROVIDER NETWORK LIAISON 3 DISCOUNT COORDINATOR in Canton, Ohio
Req# 29538 Aultman Health Foundation, CANTON, OH AULTCARE ADMINISTRATION Aultman Health Foundation Full Time, Day Shift, 8-5 PURPOSE OF POSITION: The purpose of your position is to assist the department supervisor and director with day to day operations within Networks, Credentialing and Contracting Departments. It is expected of the employee to develop, implement and maintain an accurate provider data base; analyze provider data, facilitate the preparation and follow-up of the monthly activities of the Membership Services Committee and PEER committee; track and report provider based information using Department databases; and serve as a communication link with Provider offices and other AultCare Departments regarding the status of providers. Other primary responsibilities include help with various compliance and accreditation standards that are constantly evolving throughout the department. Each person will be assigned a focus area of either membership or credentialing within the department. A level 2 is an experienced staff that has been a go to for co-workers and can often work independently and complete higher-level work to assist supervisor. A level 3 is an expert regarding department subject matter, must resolve problems with little assistance consistently assist less experienced staff and oversee processes or staff, as well as pay meticulous attention to detail. Discount Coordinator responsibilities will include negotiating discounts for high dollar claims, NSA claims and single case agreements. This will be accomplished by maintaining excellent communication skills with providers and the Claims Departments. RESPONSIBILITES/DUTIES/EXPECTATIONS: Maintain a thorough knowledge and meet important industry standards set forth by organizations such as NCQA, CMS, ODI, QHP, CAQH, etc. Helps in coordinating updating of policies and procedures as necessary to comply with these standards. Level 2 & 3 will demonstrate a working knowledge of above organizations and experience with processes related to applicable standards. Also will be responsible for maintain reporting for these entities on an ongoing basis. Level 3 become subject experts. Consistently plans, organizes and completes tasks independently and thoroughly in the allotted time frames ensuring the departments' day to day work is completed (networks, credentialing and contracting). Subject to frequent interruptions, ability to be flexible when priorities change. Level 2 & 3 demonstrates professional development and growth as evidenced by increasing responsibilities and continued success. Actively seeks and pursues opportunities to make a contribution and demonstrates desire for learning. Participates in audits as needed. Coordinates, as well as exercises good judgment in all aspects of workflow within the department. Acquires new knowledge rapidly and is aware of sources for answers to questions. Level 3 meet all deadlines, proactively foresee needs of the department, help others prioritize to ensure success and help peers with completion of their tasks as workload allows and requires. Consistently exceeds quality and productivity requirements. Supports the day-to-day operations (networks, credentialing and contracting) by making appropriate recommendations to supervisor for changes within the Department, including process improvement and problem solving. Responsible for tracking and reporting own stats. Level 2 & 3 regularly have recommended and help coordinate process improvements and problem solving. Level 3 shows technical abilities to identify cause and effect. Ability to connect the dots. It is the expectation at this level to understand small scale projects and the cause and effect on the department as a whole as well as the organization. Problem solve, handles difficult and sensitive issues with tact; exercises judgment whe