Physician Relationship Management Specialist

Northwell • Manhasset, NY

7h

About The Position

Coordinates and facilitates physician enrollment and network participation activities for various network products and Independent Practice Association (IPA). Acts as liaison between physicians, third-party insurance administrators, and departmental staff providing operational support. Works to ensure high-level customer service and physician satisfaction.

Requirements

• Bachelor's Degree required, or equivalent combination of education and related experience.
• 1-3 years of relevant experience, required.

Responsibilities

• Responds to various inquiries from participating physicians, network staff, hospital staff, and managed care companies.
• Resolves issues related to credentialing, managed care participation, claims payment, demographic changes, referrals, and accessibility.
• Responds to physician requests, provides updates and resolves issues.
• Coordinates and implements credentialing activities to assist providers with the completion of applications for network contract offerings; monitors applications and follows-up as needed.
• Conducts provider and facility credentialing and re-credentialing activities; communicates with providers to obtain requisite credentialing information to facilitate timely completion and submission of required documents.
• Facilitates re-credentialing requests and coordinates site visits related to managed care contracts.
• Prepares and reviews physician membership applications; verifies credentialing materials and enters into database.
• Communicates with providers regarding network provider enrollment policies, procedures and contractual obligations.
• Maintains provider files, as well as availability and contract-specific sentinel events.
• Assist with coordination, education and outreach; participates in community events.
• Contributes to network development by working as a key team member to build infrastructure, identify resources, and assist in operational plans.
• Implements projects and facilitates directives assigned by senior leadership; collaborates with network staff to facilitate operations.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Number of Employees: 5,001-10,000 employees