Functions as a change agent and leads Watertown Networkoffice managers to bring about process improvements and to assure bestpractices are developed; resulting in quality patient care and improvement infinancial performance of the PHO as a whole.
Develop and maintain positive relationship with PHOinsurance quality representatives. Communicate directly with insurers toreceive patient data and spreadsheets related to quality initiatives.Disseminate and share information, questions, answers and solutions withWatertown Network office managers.
Perform Hospital credentialing/re-credentialingfunctions, completing forms, sending notifications, obtaining and maintaininginformation in a timely manner as it relates to credentialing and qualityinformation.
Schedule, plan, and establish agendas and talking pointsfor Network Quality and Credentialing Committee, Network Quarterly Providermeeting and Network office manager meetings. Ensures that accurate minutes aretaken at each meeting, shares those in a timely manner and assists withpermanent filing of minutes. Responsible for annual PHO credentialing audit.
Work collaboratively with the IT programmers who willimplement the coding for larger clinical projects.
Provide written reports and results appropriate fordistribution to Watertown Network Board of Managers, clinic managers andproviders. Present data at meetings attended by board, physicians and seniorleadership.
Develop a thorough understanding of the Watertown Networkcomputing environment including the data model, file structure and fieldcontent.
Acts as a contact for queries and obtains additionalinformation for PHO insurers, providers and their clinics in a timely manner.
Communicates with clinics and business office to ensureregistration and billing information is up to date for all payers.
Timely and accurately, responds to all requests forinformation related to insurance credentialing for PHO. Submit and maintain allrequired reports per delegation agreements on a monthly, quarterly, semi-annualand annual basis.
Bachelor's degree in nursing, health care administration,health care coding, social sciences, statistics, mathematics, or relatedanalytical field, preferred.
Two years of analysis/statistical experience required, ina healthcare related field
Licenses: A valid driver's license, a reliable personalvehicle and insurance are required.
Requires critical thinking skills, decisive judgment andthe ability to work with minimal supervision. Must demonstrate a high level ofattention to detail.
Requires strong Excel knowledge. Must demonstrate amastery of Excel spreadsheets and basic macro language.
Must be able to provide leadership and strongdecision-making and problem solving skills.
Must exhibit strong organizational and communicationskills. Must be able to work under pressure and meet deadlines.
Requires an ability to participate effectively incross-departmental/clinic teams. Clinical experience and/or knowledge of healthcare systems preferred.
Initiates work assignments independently little to nodirection.