Provider Relations Rep
Wellstar Health Systems

Facility: VIRTUAL-GA

Job Summary:

The Managed Care Provider Relations Specialist will manage the plan enrollment process for all new providers joining the WellStar Physicians Group, providers joining the Locum Tenen float pool, agency providers and all other providers who bill through the Wellstar Medical Group. This individual will complete the provider enrollment applications for all assigned payors, including commercial plans and governmental plans such as Medicare, Medicaid, managed Medicaid Plans (CMO) and other applicable payors as assigned for providers billing through the Wellstar Medical Group. This individual works independently to initiate applications, to request and to process all supporting documents, to organize department correspondence, to perform other admininstrative and departments projects as assigned. This individual will also provide basic level support to the managed care department as needed. The Specialist is responsible for responding to all provider enrollment requests from managed care payors, insurance companies, Wellstar practice staff, medical staff services staff and the MGBO billing team.

Core Responsibilities and Essential Functions:

Credentialing
- completes provider enrollment applications and reports for all assigned payors, including commercial plans and governmental plans such as Medicare, Medicaid, managed Medicaid Plans (CMO) and other applicable payors as assigned for providers billing through the Wellstar Medical Group, in a format and method prescribed by the payor entity. Works independently to initiate applications, to request and to process all supporting documents for enrollment applications. Initiates, manages and completes all processes needed to insure providers remain enrolled with managed care plans as assigned. Manages the relationship with managed care payors to insure provider enrolment information is provided, processed and verified within agreed upon contractual guidelines. Customer Service and Provider Relations
- manages responses to inquiries from managed care plans, including distributing monthly, quarterly, sem-annual and annual provider demographic and credentialing information; compiles and organizes credentialing and plan participation reports; manages responses to inquires from Wellstar practice staff, the MGBO billing team and managed care related to provider enrollment; researches and advises on claims issues related to provider enrollment. Administrative Support
- Distributes and processes incoming mail, establishes provider accounts on various websites, including the Georgia Medicaid web portal (GAMMIS), manages process to secure employee access to PECOS (Medicare) and GAMMIS (Medicaid) provider web portals, updates documentation and tracking files, updates ECHO with provider plan participation information; directs processes to maintain information security and provides updated document to payors upon request. Special Projects: Assist with new projects as assigned

Required Minimum Education:

Minimum of 2 years of college or equivalent work experience in a health care organizations credentialing, billing, customer service or managed care department.
Preferred

Required Minimum License(s) and Certification(s):
All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):

Required Minimum Experience:

Minimum 2 years health care organizations credentialing, billing, customer service or managed care department Required or
Experience and extremely strong skills in internet browsers, Microsoft Word, Power Point, and Excel Required or
Database management skills desirable Required

Required Minimum Skills:

Self directed, ability to work autonomously and prioritize multiple assignments in a fast paced environment without direct supervision.
Very strong organizational skills.
Must possess an understanding of todays changing healthcare industry.
Stong communication skills, both written and verbal.
Able to interface with administrators, and providers.
Individual must have strong customer service skills.

---