• Provider Account Specialist

    Job Locations US-NC-Gastonia | US-NC-Hickory | US-NC-Statesville
    Posted Date 1 week ago(7/13/2018 9:43 AM)
    Job ID
    2018-1357
    # of Openings
    1
    Category
    Community and Social Services
  • Overview

    Excellent Benefits Package!!!

    Location: Gastonia, Hickory or Statesville

    Projected Hiring Range: $42,940 - $45.200

     

    Closing Date: 7/27/2018 by 4 PM

     

    Primary Purpose of Position: This position assists in the credentialing, development and management of the provider network for consumers who have been identified as having mental health, substance use or intellectual development disability needs.

     

    Responsibilities

     

    Role and Responsibilities:

    A Provider Network Account Specialist primary duties may be one or more of the following:

    • Contract Negotiations with Providers
      • Assist with development and implementation of contracts for agencies and licensed independent practitioners
      • Conduit for funding requests and change requests for approval
      • Work with finance to track and monitor utilization of all funding mechanisms
    • Provide Back-up to monitor team as needed to complete reviews.
      • Initial Onsite Health & Safety Reviews
      • Routine Monitoring
      • Unlicensed AFL Reviews
    • Technical Assistance-Assisting providers as needed with our internal systems-authorization, claims, alpha issues.
    • Serves as a resource to other departments within the LME/MCO on provider-related issues.
    • Coordinate meetings with Providers and Internal staff
    • Participates in Provider Forums as requested and provide technical support and assistance to Provider Councils as needed
    • Participate in internal workgroups that involve existing providers.
    • Provide Orientation with New Providers
    • Assist with Identifying & developing provider training to meet provider needs.
    • Assigned to DOJ/TCL initiatives.
    • Development of Policy & Procedure, and notifications associated with Contract Performance monitoring.
    • Review and Approval of HCBS assessments
    • Contract Performance Monitoring
    • Responsible for pulling multiple reports from ALPHA/Report Manager/ACORN to share with providers for them to improve upon; such as, 1st responder report, NC TOPPS, ED admissions.
    • Participation in internal and external committees.

     

    Knowledge, Skills and Abilities:

    • Considerable knowledge of the laws, regulations and policies that govern the program
    • Exceptional interpersonal and communication skills
    • Strong problem solving, negotiation, arbitration, and conflict resolution skills
    • Excellent computer skills and proficiency in Microsoft Office products (such as Word, Excel, Outlook, and PowerPoint)
    • Demonstrated ability to verify documents for accuracy and completeness; to understand and apply laws, rules and regulations to various situations; to apply regulations and policies for maintenance of consumer medical records, personnel records, and facility licensure requirements
    • Ability to make prompt independent decisions based upon relevant facts
    • Ability to establish rapport and maintain effective working relationships
    • Ability to act with tact and diplomacy in all situations
    • Ability to maintain strict confidentiality in all areas of work

     

    Qualifications

    Education/Experience Required:

    Bachelor’s Degree and two (2) years of case management, auditing or monitoring experience in MH/SU/IDD. A valid driver’s is required.

     

    Education/Experience Preferred:

    Master’s Degree with clinical licensure preferred.

     

    Licensure/Certification Requirements:

    NA

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