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Work Shift
Day
Work Day(s)
Friday, Monday, Thursday, Tuesday, Wednesday
Shift Start Time
9:00 AM
Shift End Time
5:00 PM
Worker Sub-Type
Regular
Children’s is one of the nation’s leading children’s hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We’re committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. Find your next career opportunity and make a difference doing what you love at Children’s.
Job Description
Serves as liaison between physicians, office managers/staff and contracted managed care payors and provides recruiting and contracting functions for the physician-hospital organization.
Job Profile Summary
Serves as liaison between physicians, office managers/staff and contracted managed care payors and provides recruiting and contracting functions for the physician-hospital organization.
Experience
- 5 years of experience in managed care
Preferred Qualifications
- 3 years of experience in provider relations
- Experience in physician recruiting/contracting
- Experience in credentialing function and credentialing software
- Working knowledge of Cactus Software
Education
- Bachelor’s degree in Business or health-related discipline or 10 years of experience in physician office billing, managed care, or provider relations or an equivalent combination of education and experience
Certification Summary
- No professional certifications required
Knowledge, Skills, and Abilities
- Working knowledge of physician office operations, managed care operations, hospital and physician registration/admitting, billing, and utilization review operations
- Working knowledge of various payor fee schedule methodologies
- Strong organizational, communication, and interpersonal skills
- Working knowledge of software applications (Microsoft Word, Excel, and Access)
Job Responsibilities
Operations:
- Supports the Contract Operations Manager by providing oversight, ownership, management, and timely resolution of escalated payor operational issues related to assigned payors, including scheduling, and managing operational meetings/calls with assigned payors at least monthly.
- Composes provider alerts to facilitate timely communication of relevant information to provider groups, including drafting payor alerts, anticipating questions from network providers, determining audience and delivery methods, and obtaining manager approval.
- Works productively with The Children’s Health Network team members and provider groups to efficiently identify issues and groups impacted.
- Debriefs/updates The Children’s Health Network team members of payor issues, including debriefings at The Children’s Health Network operations meetings.
- Supports department with site visits, service calls, provider updates, credentialing activities, election process, data base updates, and other tasks as needed.
- Uses, maintains, and monitors all departmental databases (e.g., provider relations database, provider tracker, Valence) to ensure issues and data are tracked, updated, and resolved appropriately.
- Ensures that each provider office is kept informed in a timely manner of new payor contracts, payment policies, and other relevant information.
- Ensures provider’s understanding of payor reimbursements via provider office meetings, telephone conferences, provider alerts, and newsletters.
Account Practice Partner:
- Develops relationships with assigned practices.
- Completes other duties and projects as needed or assigned.
- Supports claims data submission and assists with provider compliance.
- Educates practices on contracted metrics and understanding of the Provider Scorecard.
- Works with practices to understand minimum standards and corresponding expectations.
- Educates assigned practices on current TCCN Provider Incentive Programs.
- Completes other duties and projects as needed or assigned.
Children’s Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law.
Primary Location Address
1575 Northeast Expy NE
Job Family
Physician Relations
Top Skills
What We Do
We know children need specialized pediatric care. Our team makes sure your child is comfortable and happy while in our care. We're committed to making all kids better today and healthier tomorrow.
