Enter payors in the provider's computer profile. Send enrollment applications to commercial and state payors. Work as a liaison between the payor and provider. Send applications to appropriate hospital divisions/providers for signature. Contact representatives from commercial payors, state Medicare/Medicaid, and hospital divisions via e-mail or telephone to check enrollment status of providers. Update in computer database the expected date the application is to be returned by state payors and by hospital divisions. Identify and resolve enrollment issues with third party payors as well as maintain providers' eligibility with contracted payors.
Coordinate, perform and track required expirables e.g. licensure, DEA certificates, TB testing, annualinfluenza, specialty boards (MOC), advance life support and malpractice information for all appointees according to established law, policies and procedures. Establish and maintain providers' eligibility with core payors with regards to updated licensure information. Monitor information collection. Perform cognitive analysis of all information received; evaluate adequacy and quality, pursue additional information as needed. Serve as liaison between contracted payors and Cincinnati Children's departments/divisions.
Coordinate, enter and maintain information for all employed appointees in the CAQH application. Information includes but is not limited to education, specialty and board certification, licensure, practice locations, and malpractice information.
Provide support in obtaining required information for reappointment of the medical staff and allied health professional staff according to established law, policies and procedures. Analyze information obtained to determine if further action is required.
UPIR Database (As of 11/19/15 Referring Database)
Coordinate, perform and track information regarding referring physicians, residents, fellows, APNs/PAs and appointees of the medical staff according to established law, policies and procedures. Monitor
information collected. Perform yearly audit to determine providers are still licensed practitioners.
Serve as liaison between house staff, graduate medical education, scheduling center, information services and physician services.
Customer Service & Development
Respect patient/medical staff rights for informed consent and the handling of confidential information. Review timeliness, accuracy, availability and security of information. Participate in improving
organizational performance through recommending areas or approaches for improvement activities, performing new procedures, collecting data and providing input to department discussions. Understands, adheres to
and models Cares Standards as defined organizationally and specifically within the department.
Telemedicine and Delegated Telemedicine Credentialing Agreements
Responsible for completing required documents/applications for credentialing CHMC providers at non-CHMC facilities who are providing telemedicine services. Responsible for collecting required documentation and completion of required documents for CHMC providers where there is a delegated credentialing agreement in place for telemedicine services.