Outsourced Credentialing Coordination •Seve as primary day-to-day liaison to the outsourced credentialing partner and monitor enrollment, recredentialing, payer loading, and outstanding deliverables. •Collect and validate provider documentation, including licenses, DEA, malpractice, CAQH, board certification, and enrollment records. •Coordinate provider onboarding, location additions, transitions, roster reconciliation, and status reporting; escalate delays to the RCM Manager.
athenaOne Enrollment Worklist & System Updates •Monitor and maintain the athenaOne enrollment worklist, ensuring provider and payer enrollment tasks, statuses, follow-up dates, and supporting notes are current and accurate. •Coordinate with the outsourced credentialing partner to reconcile worklist items against submitted applications, payer acknowledgments, approvals, denials, and effective dates. •Enter or coordinate timely updates to provider enrollment records, payer participation information, and applicable provider or location details in athenaOne within assigned access and approval protocols. •Identify stalled, incomplete, duplicate, or inconsistent worklist items; obtain missing information, document follow-up, and escalate issues that may delay claims submission or reimbursement. •Validate payer enrollment completion and effective dates against written payer confirmation before marking worklist items complete; communicate material changes to RCM and operational stakeholders. •Prepare routine athenaOne enrollment worklist aging, outstanding-item, and completion reports for the RCM Manager.
Payer Relations & Verification •Verify provider, group, and facility network participation, effective dates, affiliations, payer products, and service locations. •Research payer enrollment and participation requirements and resolve discrepancies through documented payer follow-up. •Support payer projects, roster updates, demographic changes, and contracting implementation activities. Payer Contract Management & Administration •Maintain a comprehensive, centralized repository of professional, ancillary, laboratory, and ASC payer agreements, amendments, fee schedules, and related documents. •Request missing executed agreements, amendments, reimbursement exhibits, and supporting documentation from payer representatives. •Maintain a contract inventory of entities, TINs, NPIs, locations, effective dates, renewals, termination notice requirements, and applicable products or networks. •Track renewal, amendment, and notice deadlines; verify participation and contract loading; identify discrepancies with payer rosters and internal records. •Support contract research, payer outreach, documentation gathering, and implementation tracking; maintain correspondence logs and escalate risks to the RCM Manager.
Acquisition & Payer Notification Management •Coordinate payer notifications and documentation for acquired practices, providers, facilities, and business entities. •Maintain an acquisition payer notification matrix with impacted payers, entities, requirements, deadlines, owners, submissions, acknowledgments, and status. •Research payer-specific requirements for asset and stock purchases, changes of ownership or control, TIN/NPI changes, and provider or facility transitions. •Prepare and distribute payer acquisition notifications after RCM leadership and, where appropriate, Legal approval. •Request current contracts, provider and location rosters, and written participation confirmations for acquired entities. •Coordinate with payer network management and the outsourced credentialing partner on transition requirements, amendments, enrollment, and roster updates. •Track payer responses and implementation milestones; obtain written confirmation of effective dates and outstanding actions. •Escalate network gaps, delays, and reimbursement risks; provide regular transition status reports.
ASC Licensure & Facility Support •Provide administrative support for credentialing, enrollment, recredentialing, and payer contracting activities across CPS-affiliated ambulatory surgery centers. •Coordinate with the outsourced credentialing company, ASC operations, RCM leadership, and payer representatives to facilitate facility enrollment and network participation. •Gather and maintain ASC licenses, Medicare certifications, accreditation records, applicable CLIA certificates, NPIs, TINs, ownership records, and other payer-required documentation. •Assist with completion, submission, and tracking of ASC enrollment applications, demographic updates, facility additions, and recredentialing requests. •Request and organize executed ASC payer agreements, amendments, fee schedules, reimbursement exhibits, and related documentation. •Maintain an ASC contract and payer participation inventory documenting entities, facilities, networks, effective dates, renewal terms, and termination notice requirements. •Coordinate administrative follow-up with payer network management and contracting representatives regarding documentation, agreements, and implementation status. •Track ASC contracting projects, outstanding payer responses, facility loading, implementation milestones, and unresolved issues; obtain written payer confirmation when available. •Support acquisition-related ASC payer notifications, ownership updates, and facility transitions in coordination with RCM leadership and Legal. •Monitor licensure, accreditation, certification, and enrollment renewal dates; escalate impending deadlines and potential participation or reimbursement risks. •Provide timely status reporting and maintain accessible records of payer correspondence, submissions, and confirmations. Scope of authority: This is an administrative coordination role. The liaison does not independently negotiate reimbursement rates or contract terms, approve proposals, execute agreements, or make final contracting decisions. Such authority remains with designated CPS leadership.
RCM Project & Administrative Support •Maintain accurate electronic files, project trackers, action logs, and weekly status reports. •Support payer audits, practice expansions, operational transitions, and special projects assigned by RCM leadership. •Collaborate with RCM, clinical operations, finance, compliance, and external partners while protecting confidential information.
Key Performance Expectations Area Expectation Vendor Coordination Timely follow-up and escalation of open credentialing items Payer Verification Accurate, documented participation and effective-date verification Contract Inventory Current agreements, amendments, and tracked contract deadlines Acquisition Notifications Track notifications through acknowledgment and resolution Payer Transition Tracking Accurate acquisition action-item and implementation trackers ASC Documentation Current licensure and certification records
Reporting & Escalation Weekly status updates and prompt escalation of revenue risks