Job Description
Job Description
- Key Responsibilities:
- Schedules and organizes work assignments. Prioritizes and delegates job tasks to ensure timely completion. Ensure work is performed accurately and efficiently.
- Ensure department response to verbal and written internal or external customer inquiries within policy and procedure timeline.
- Assists in the review, development and maintenance of departmental policies and procedures, and advises on the development of overall guidelines and best practices.
- Implement policies and procedures to maintain workflow standards.
- Maintains manuals of policies and procedures, contract guidelines, and other relevant reimbursement material.
- Oversee daily department activities per policies and procedures.
- Audit department functions for compliance with policy and procedure, contract, and government regulations.
- Effective improvement of operational processes to achieve maximum efficiency, accuracy, and data integrity.
- Research and analyze complex issues. Resolves claims issues related to practitioner or group enrollment and identifies and communicates opportunities for process improvements.
- Collaborates with the legal, compliance, tax and other departments to obtain and or ensure maintenance of certifications, licenses or other documents necessary for compliance with Government and Third-Party payor credentialing and or initial or ongoing enrollment requirements.
- Maintain and track business licenses and regulatory filings.
- Address problems as they occur. Keep manager advised of areas of concern or compliance issues which may lead to deactivation of enrollments or inaccurate completion of responsibilities.