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Provider & Network Coordinator

Company: Beacon Health Options
Location: Wixom
Posted on: September 17, 2020

Job Description:

Beacon Health OptionsJob Category: Provider & Network - Relationship MgtReq #: NETWO02882Schedule: Full TimeLocation: MI - WixomWe Help People Live their Lives to the Fullest Potential!

For more than 30 years, Beacon has changed the way people live with behavioral health conditions. Today, we are the undisputed leader in behavioral health management, serving 40 million people across all 50 states. At Beacon, we are committed to delivering a 'world-class' candidate experience from the moment you click 'Apply'! Our goal is to help you reach your fullest potential, while utilizing your talents and expertise to help us deliver on our promise.

Do you have a passion for helping others? If so, we are looking for you!

Beacon is currently seeking a Provider & Network Coordinator to join our team in Wixom, MI. Responsible for various levels of activities supporting the recruitment, credentialing and contracting process for potential and current Beacon providers. Responsibilities may range from maintenance support, provider education and communication with internal customers and Beacon providers, to reviewing provider files/programs and monitoring program compliance with applicable standards and regulations. Responsible for phone coverage. Provides internal support and follow-through in completion of the Provider Relations functions. Supports the local provider relations staff, including provider relations managers by providing research, problem resolution, administrative support and follow-up on a variety of provider issues that may arise. Coordinates activities with other internal Beacon departments to provide optimal customer service to network providers and internal customers. Special projects and other duties as assigned.

What does a typical day look like?

  • Answers practitioners'/facility recruitment questions regarding Beacon policies and procedures, contracting requirements, and claims issues. Participate in responding to provider inquiries and problems.
  • Provides follow up with practitioners and facilities for the return of completed credentialing and re-credentialing applications and contract documents. Verifies claims and application information with providers to update database. Process letters of resignation and may initiate disenrollment's. Responds to provider requests for credentialing information.
    • Provides assistance in compilation and mailing of provider recruitment mailings, general information and educational materials to network practitioners as required. Assists Provider Relations Managers with research to identify new providers for recruitment into the Beacon provider network. Initiates written requests to providers for credentialing information. Responsible for the coordination and implementation of activities necessary for the identification, review and selection of mental health and substance abuse treatment providers in support of Beacon Network Development. Performs research and problem resolution on issues related to provider complaints, claims reported to have been processed incorrectly, coordinating credentialing paperwork, provider communications or verification of information as requested. Assists Provider Relations Managers with report requests for network management purposes. Reviews/analyzes provider information through database queries. Review denial reports, weekly approval disenrollment grids and research information regarding this provider and the area(s) served. Meet with Provider Relations Managers and Director, Provider Relations staff and Service Center staff to present information discuss plans of action to avoid disenrollment of key providers. Researches files and databases to address provider questions. Analyze beneficiary and provider demographics and generate proposed network configuration for review and incorporation into formal master plans produces by the Network Development Unit. Participate in the analysis and monitoring of provider utilization and performance data to ensure appropriate utilization for network providers and identify needs for network modifications as well as for initial and ongoing network configurations. Resolve customer/member/provider claims issues through investigation and problem solving. Follow-up on inquiries as needed, referring problems to other appropriate Beacon personnel as identified. Reviews/analyzes providers' status through database queries. Researches files and databases to address provider questions. Prepares and disseminates reports.
      • Obtain, process, manage and maintain both hard-copy and computer based provider information necessary for network development and maintenance activities. Participates in the maintenance for files within a national database of potential and existing network providers. Attend all staff meetings, team conferences and in-service as directed. Maintain daily logs for future reference and analysis as well as document inquiries and complaints appropriately in MHS, Phoenix and Prism. Enter data accurately and timely into systems. Perform routine clerical functions including filing, copying, faxing, typing and record retrieval.
        • Works closely with regional Network Operations team to ensure seamless customer service to providers. Interface with MSR, Care Managers and Claims staff to give information about provider contract/credentialing status to facilitate claims payment and referrals. Interface with external and internal customers to ensure optimal efficiency of service. Address concerns of dissatisfied and/or angry customers/members/providers in a diplomatic manner. Respond to customer inquiries professionally and efficiently. Assist in day to day departmental activities including phone coverage and file maintenance.
          • Apply Beacon policies and procedures consistently. Maintain confidentiality of Clients, Business Records and Reports. Maintain ethical and professional standards. Maintain individual productivity and performance standards. Meet Departmental expectations, accuracy, productivity and performance standards. Support Beacon in achieving Mission Statement. Adhere to the components of the Compliance Program. Ensure that job tasks are performed in a legal and ethical manner. Actively assess work area for non-compliance issues and notify supervisor or call Ethics Hotline. Adhere to compliance training requirements and understand that training is required condition of employment. Complete tasks accurately and within required time frames.
            What you Contribute?

            Education: This position requires a Bachelors' Degree in a Human Services field, equivalent Bachelor's Degree or equivalent work experience in a behavioral health or managed care environment in lieu of a Bachelor's degree.

            Licensure: NA

            Knowledge, Skills & Abilities: At least three years of experience in customer service, claims, auditing or provider relations in the behavioral health or managed care setting is required. Knowledge of and experience in provider benefits administration/health care setting. Knowledge of and experience with providers and provider network. Excellent verbal and written communication skills. Have a professional bearing and be able to speak comfortably with physicians, senior facility administrator and mental health professionals. Have strong problem-solving skills. Position requires some travel.

            What Makes Us Different?
            • Here, it's not just a job - it's an opportunity to change lives.
            • Our employees are learners, innovators and original thinkers.
            • Our mission and values guide the way we treat our members, providers and each other.
              What We Have to Offer:
              • Healthcare benefits available starting day 1!
              • Health & wellbeing incentives, such as gym membership reimbursement
              • 401K with company match to help reach your future financial goals
              • Generous PTO, because we know life happens outside of work
                If Beacon sounds like the place for you, what are you waiting for? Apply with us today to get started!

                Click below on "Apply for this Position" to create a profile and apply for the position

                Beacon Health Options company, is proud to be an Equal Opportunity and Affirmative Action Employer as well as a Drug Free and Tobacco Free Work Environment. EOE/AA/M/F/Veterans/Disabled

                At Beacon Health Options, our candidate's data privacy is a top priority. Our recruiting team conducts all communications using official company email (@BeaconHealthOptions.com). Only candidates who have applied for an open position through our Careers page (careers.beaconhealthoptions.com) will be engaged in our interview process. Beacon conducts all interviews in person or over the phone. At no time during the recruiting process will any Beacon recruiter request any financial or personally identifiable information from you.

                #PM16

                #GD

                #LI PI123132515

Keywords: Beacon Health Options, Detroit , Provider & Network Coordinator, Other , Wixom, Michigan

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