Provider Network Analyst

Location
Gaithersburg, MD
Posted
Aug 09, 2022
Closes
Oct 08, 2022
Ref
R-021766
Industry
Healthcare
Hours
Full Time
Adventist HealthCare seeks to hire a Provider Network Analyst who will embrace our mission to extend God's care through the ministry of physical, mental, and spiritual healing.

As a Provider Network Analyst you will:
• Be under general direction of the AVP of Managed Care, the Provider Network Manager is responsible for practice operations, financial and revenue cycle management, managed care contracting and credentialing for all Adventist Medical Group (AMG), Adventist HealthCare Urgent Care, The Reginald S. Lourie Center and all allied health practices.
• Facility Credentialing - provide oversight to ensure providers are in compliance
• Work collaboratively with AHC Medical Staff Offices to obtain Provider staff privileges
• Create workflows within Morrisey Credentialing database to process new provider applications
• Collaborate with Medical Staff Offices to ensure proper credentialing documentation is received
• Insurance Credentialing - Responsible responsible for the credentialing processes of all Adventist Medical Group (AMG), Adventist HealthCare Urgent Care, The Reginald S. Lourie Center and all allied health professionals
• Maintain extensive communication with providers to establish and maintain positive relationships throughout Adventist HealthCare
• Create and manage Council for Affordable Quality Healthcare (CAQH) database for all employed physicians and clinical staff for third-party vendor access
• Manage all payer credentialing and re-credentialing
• Maintain updates for all Adventist Medical Group, Adventist HealthCare Urgent Care, The Reginald S. Lourie Center, and all allied health practices
• Collaborate with third-party administrators, payers, and AHC Medical Staff Offices to ensure network accuracy of physician data
• Manage the processing of physician credentialing for multiple business units
• Prepare and submit all credentialing and recredentialing applications for all employed and contracted providers
• Send monthly updated rosters to delegated payers for credentialing.
• Add providers to and delete providers from payer contracts
• Build and maintain professional relationship with all payers
• Follow up with payers as needed
• Maintain Adventist Medical Group provider database and update as needed
• Collaborate with Adventist HealthCare's Legal Department to ensure all correspondence is submitted to obtain malpractice insurance
• Maintain current provider roster and provide data to contracted payers
• Provide guidance and support to all providers and office staff
Establish and maintain effective working relationships with employees, payers • and patients
• Work collaboratively with all practices to ensure efficient and effective operations
• Collaborate with Adventist HealthCare leadership to identify operational issues and develop resolutions
• Review and process all invoices for payments, refunds and reimbursement
• Provide support and leadership on business areas including financial reporting and resource management.
• Collaborate with billing company to identify and correct provider credentialing claims denial and timely claim submission
• Provide guidance to new providers on billing guidelines
• Provide project management support for the Clinically Integrated Network
• Conduct provider onboarding meetings
• Knowledge of healthcare practice and management
• Ability to guard confidential information
• Ability to organize and integrate organizational objectives in order to meet deadlines
• Ability to assume responsibility and exercise authority over assigned work functions
• Ability to analyze situations and taking effective action
• Ability to work Independently
• Ability to multi-tasks and manage time effectively

Qualifications Included:
• High school diploma/GED required, Bachelor's degree in Business Health/Administration preferred.
• Ten (10) years' healthcare office administration experience.
• Five (5) years' supervisory/management experience.
• Knowledge of Revenue Cycle
• Knowledge of Provider Credentialing / Provider and billing
• Effective project management skills
• Excellent written and verbal communications skills
• Proficient in Microsoft Word and Excel
• Strong organizational and interpersonal skills
• Experience with MSOW credentialing software
• Knowledge of EClinical Works

At Adventist HealthCare our job is to care for you. We do this by offering:
• Work life balance through non rotating shifts
• Recognition and rewards for professional expertise
• Free Employee parking
• Competitive comprehensive benefit plans offered (including health, disability,
PTO and 403B retirement plan with matching and 3 year vesting)
• 100% Coverage for inpatient care - at Adventist HealthCare facilities
• 100% Coverage for urgent care nationwide - after copay

As a faith-based organization, with over a century of caring for the communities in the Maryland area, Adventist HealthCare has earned a reputation for high-quality, compassionate care. Adventist HealthCare was the first and is the largest healthcare provider in Montgomery County.

If you want to make a difference in someone's life every day, consider a position with a team of professionals who are doing just that, making a difference.

Join the Adventist HealthCare team today!

Work Schedule:

Full Time, Days Shift, Monday - Friday

COVID-19 Vaccination

Adventist HealthCare requires all applicants to be fully vaccinated for COVID-19 before commencing employment. Applicants may be required to furnish proof of vaccination and , if offered, may elect to be vaccinated at a n designated Adventist HealthCare location.

Tobacco and Drug Statement

Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine and drug use.

While some jurisdictions, including Maryland, permit the use of marijuana for medical purposes, marijuana continues to be classified as an illegal drug under the federal Controlled Substances Act. As a result, medical marijuana use will not be accepted as a valid explanation for a positive drug test result.

Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine) and marijuana. Those testing positive are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing.

Equal Employment Opportunity

Adventist HealthCare is an Equal Opportunity/Affirmative Action Employer. We are committed to attracting, engaging, and developing the best people to cultivate our mission-centric culture. Our goal is to have a welcoming, equitable, and safe place to work and grow for all employees, no matter their background. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.

Adventist HealthCare will make reasonable accommodations for applicants with disabilities, in accordance with applicable law. Adventist HealthCare is a religious organization as defined under applicable law; however, it will endeavor to provide reasonable accommodations for applicants' religious beliefs.

Applicants who wish to request accommodations for disabilities or religious belief should contact the Support Center HR Office.

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