Provider Contracting Assistant (Hybrid - Troy, MI) - Health Alliance Plan

GENERAL SUMMARY:

Coordinate processing and maintenance of provider contracts and maintenance of provider demographic information including new contracts, terminations and modifications, and configuration of Contract Manager, Facets or its successor systems. As a team member, provide administrative support, coordinate, and prepare appropriate correspondence/contracts/audits for regulatory agencies, network maintenance projects, and strategic initiatives.

DUTIES & RESPONSIBILITIES:

• Conduct activities to enroll providers for participation with HAP including pre-screening, preparing, and sending credentialing applications and contracts to providers, coordinating with delegated networks, and maintenance of tracking logs of all provider enrollments.
• Prepare contracts in the Contract Management System, send contracts to providers, and track contracts through approval process.
• Prepare Provider Reimbursement Worksheets (PRW's) and or Ancillary Reimbursement Worksheets (ARWs) in accordance with departmental procedures for provider enrollments, terminations, demographic changes or other modifications.
• Assist department with all Single Case Agreements, regulatory reporting and audits, and special projects as needed.
• Resolve provider enrollment and provider inquiries in assigned Pega workbasket. Maintain caseload in Pega workbasket and email boxes on a regular basis.
• Assist department staff with telephone triage, field provider calls and direct as appropriate, assist internal departments with provider inquiries and reimbursement verification.
• Assist and participate in the interpretation, summarization, communication, and recommendation on key elements of provider contracts to the appropriate individuals both internal and external to the organization.
• Assist and participate in timely triage and resolution of provider issues.
• Assist and assume responsibility for focused projects within the department relating to provider contracting.
• Perform other related duties as assigned.

HAP Pay Grade: 18 (non-exempt)