Missouri Primary Care Association ["MPCA"]
Payer Relations Coordinator
Monday through Friday
Sr. Director, Payer Relations
Eligible for Remote:
Jefferson City, MO [on-site]/Remote
The Payer Relations Coordinator will assist with functions and aspects of the credentialing and recredentialing process for health care providers who are participants with MissouriHealth+ (MHP). The Coordinator builds and maintains successful working relationships with members and payer partners including Managed Care Organizations (MCO) and Missouri Medicaid. The Coordinator will process medical, dental and behavioral health provider applications, verify information, research application details, and assure processes are followed in accordance with the credentialing policy guidelines and procedures. The Coordinator will provide consistent, accurate and timely credentialing support, enhancing the organization’s ability to provide professional services. Work includes accurate, timely and documented verification of the information provided in the credentialing application and maintenance of highly confidential credentialing related files. The coordinator will provide administrative support, including in various aspects of value based care and provider engagement.
- Performs primary source verification for medical school, residency, fellowship, NPDB and other entities.
- Processes provider credentialing and re-credentialing applications in accordance with accreditation standards, regulatory requirements, and policies and procedures.
- Examines, researches, enters data and gathers all information necessary to process information received from providers to support the credentialing and re-credentialing process.
- Maintains compliance with documentation standards for verification of provider credentialing requirements, including but not limited to licenses, certifications, registrations, permits, educational degrees, and association memberships.
- Supports MHP’s Credentialing Committee and annual audits.
- Ensures the maintenance and accuracy of electronic provider credentialing and re-credentialing files.
- Supports liaison with MCOs address health center provider load discrepancies and claim denials.
- Develops and maintains ongoing collaborations and partnerships with MCOs to remain current on operational efficiencies and value based care.
- Performs administrative support within MHP and MPCA, including value based care initiatives.
- Other duties as assigned.
- High school diploma or equivalent, required. Bachelor’s Degree preferred.
- One to three (1-3) years’ experience within a medical, dental or behavioral health practice.
- Credentialing experience preferred but not required.
- Ability to drive an automobile and possess a valid driver’s license.
- Experience working with Federally Qualified Health Centers (FQHC) or Community Mental Health Center (CMHC) is a plus.
- Experience using CAQH Solutions ProView is a plus.
- Familiarity with NCQA and delegated credentialing processes a plus.
- Solid knowledge of Microsoft Programs, including Excel required.
- Strong attention to detail.
- Credentialing experience.
- Accurate and timely data entry skills.
- Experience with credentialing software program.
- High degree of resilience, persistence and the ability to thrive in an environment of rapid change.
- Ability to work independently and on multiple projects.
- Ability to make routine decisions in accordance with departmental policies and procedures.
- Must have strong organization, interpersonal presentation and time management skills.
- Team player both within and across teams.
- Excellent organizational, written and oral communication skills.
- Culturally Competent
- Ability to sit, stand, walk, reach and use hands and fingers for extended periods of time.
- Performing physical activities which require considerable use of your arms and legs for moving your entire body, such as climbing, lifting, balancing, walking, bending, kneeling, crawling, stooping, and handing of materials.
- Ability to read computer screens, mail, e-mail and talk on the phone.
- Ability to unpack and move supplies up to thirty (30) pounds.
- Ability to drive an automobile.
- Professional and deadline-oriented environment in an office or remote setting.
- Interaction with internal and external customers.
- Job duties will be performed onsite, at the Jefferson City, MO location with options for remote work.
- Job duties will be performed either from a remote office location or onsite, at the Jefferson City, MO location
- Travel will be minimal to meetings and events in the local Missouri area.
Additional duties and responsibilities may be added to this job description at any time. The job description does not state or imply that these are the only activities to be performed by the employee(s) holding this position. Employees are required to follow any other job-related instructions and to perform any other job-related responsibilities as requested by leadership.