+ Manage a network of Ancillary Providers for all lines of Healthfirst's business (such as Medicaid, CHP, Medicare, and Commercial).
+ Monitor and audit contracted ancillary providers to ensure that accurate demographic, payment and fee schedules are loaded into the HF Provider System correctly.
+ Resolve configuration issues by identifying root causes in order to prevent claims denials and to ensure claims are paid correctly.
+ Facilitate meetings cross-departmentally to achieve positive outcomes in management of ancillary provider network.
+ Create contracts in HF contract software and review credentialing documents submitted by Provider/facility via Universal Credentialing Data Source, The Council for Affordable Quality Healthcare (CAQH) or PDF application to ensure that all the required credentials are included and that valid documents for behavioral Providers and facilities are provided
+ Negotiate and execute Single Patient Agreements for Out Of Network (OON) Provi...