Health Care Consultant

The Health Care Department of one of the fastest-growing accounting firms in the country is seeking a Health Care Consultant who possesses a strong technical skillset, is motivated by quality work and embraces a collaborative environment. This individual will have a direct impact on our firm’s mission of serving as a catalyst for those striving to achieve their highest potential.  

As a member of the Health Care team, this role is accountable for end-to-end management and completion of initial/renewal provider enrollment applications to satisfy the scope of deliverables aligned with the client’s Agreement. Independently works to resolve issues related to credentialing and enrollment methodologies to minimize delays for credentialing entities to complete their processes for approval. The Health Care Consultant is responsible for managing all delegated tasks to complete the scope of deliverables while ensuring all delegated tasks are completed within the project budget and exceeds the client’s expectations.

A significant scope of this role is responsible to foster positive relationships with clients and oversee the day-to-day relations with clients, their personnel, and providers. This individual’s daily functions include working independently with clients, their personnel, providers, health plans, and hospital leaders effectively to accomplish the various elements to ensure timely and accurate completion of their assigned tasks. The Health Care Consultant must deliver exceptional client service, which is an expectation representing Anders vision, mission and core values.  

What You’ll Do:

Credentialing, Recredentialing Applications and Payer Enrollment                                                  

• Establish and maintain professional relationships with Client’s offices to ensure proper handling of required information and documentation to ensure a timely outcome of all areas of requested statement of work
• Carry out various credentialing processes in relation to physicians, allied health providers, and various other professionals
• Responsible for creating and managing a matrix of client data to support the scope of deliverables
• Create client’s data and information in credentialing data platform timely not to exceed 3 business days from receipt of documentation (if applicable)
• Responsible for completing applications and issue-resolution on behalf of providers, including communicating with payers to ensure timely application approval
• Process enrollment requests/submissions to all applicable commercial, state and federal health plans (either through the health plans designated process or through our partnered US CVO delegated processes) – For both initial enrollments and renewals/revalidations
• For select providers, process hospital medical staff applications for initial appointments and reappointments
• Communicate the status of the scope of deliverables to the client by email on a weekly basis or as preferred by the client
• Communication liaison between Client, their personnel, providers and all applicable credentialing entities including any and all practice status changes and demographic information that may require updates
• Adhere to internal policies regarding comprehensive follow up guidelines established for communication with all credentialing entities
• Create and maintain CAQH provider profiles for new and existing providers on an ongoing basis. Review profiles for errors and correct accordingly
• May delegate the data entry and maintenance of a provider’s CAQH profile. Responsible for ensuring the provider’s data has been entered and updated correctly
• Utilize advance problem-solving skills to resolve issues and conflicts that may arise
• If Applicable update PECOS/NPPES and State Medicaid portals
• Process or delegates the primary source verification for initial and recredentialing medical staff applications in accordance with the client’s bylaws, rules and regulations and policies and procedures.
• Maintain the ability to identify red flags in credentialing and communicate with health care practice leaders to co-assign a level of severity before reporting to the client.
• Must be able to complete or delegate the primary source verification and produce a file for internal review; if review is complete, compiles all documentation in Adobe for the client.
• Conduct or delegate follow-ups with credentialing entities regarding application status and demographic updates
• Maintain an in-depth working knowledge of the requirements established by credentialing entities and provide updates of any significant changes to clients
• Identify issues that require additional investigation and evaluation, validate discrepancies and complete appropriate follow up and communicate as needed with the health care practice leader
• Complete special projects within time frames requested by leadership

 

Management of Client Data             

• Manages the monthly maintenance of clients data for existing providers and other entities
• Delegates and manages CAQH provider profiles to ensure provider information and documents are up to date in accordance with the National Committee of Quality Assurance (NCQA) standards. Ensures that the CAQH provider profiles are attested to at least once every 120 days
• Ensures timely completion of client and provider renewals/recredentialing/revalidations required by all credentialing entities
• Generates monthly client/provider expiration reports and communicates effectively with client/providers to ensure timely receipt of expiring documents, e.g. licenses, CDS, BNDD, DEA, Boards, Malpractice Insurance, etc.
• Accountable for terming providers or locations with payers upon client request in a timely manner not to exceed 30 days from receipt of client’s notice
• Ensures timely completion and submission of all requested recredentialing/renewal applications
• Collaborates with client and health plans related to non-network rejected or denied claims seeking resolution for correct payment processing of claims; Seeks input from health care practice leaders when necessary
• Maintain and manages all client data in Health Care’s internal data credentialing platform
• Provide periodic provider rosters to health plans and other organizations as required by contractual relationships to meet our payer reconciliation process
• Complete payer directory updates at least every 90 days in accordance with the No Surprise Act
• Maintain demographic updates required for compliance with CMS quarterly updates

 

Client Meetings

• The Health Care Consultant is responsible for accepting new client assignments, preparing and managing the new client kickoff meeting
• Independently manages, coordinates and participates in monthly conference calls with clients regarding providers and payers
• Prepares or delegates the preparation for meeting agendas; takes minutes as a method of communication of next steps to clients/providers and the Anders Health Care Services team. The meeting minutes are compiled and submitted to the client for review and approval within 24 hours from the meeting occurrence; Minutes are filed electronically in the client’s shared drive
• On-site meetings are coordinated with the client at least quarterly to once a year depending on client preference

 

General Responsibilities                                                                                 

• Documents work hours appropriately in Anders CCH Axcess daily
• Notifies Health Care Practice Leaders of potential concerns outside of employee’s scope of responsibility
• Participates in education and training events to build a working knowledge and to enhance expertise for related roles and responsibilities and/or professional development
• Attends Health Services staff meetings, ancillary and firm meetings
• Health Care Consultant maintains knowledge of all Anders services for cross-selling opportunities
• Collaborates with internal marketing to create and publish a blog
• Perform other duties as assigned

 

What We’re Looking For:

• Possess an understanding of credentialing, licensing, and payer enrollment to include hospitals, medical groups, health systems, state licensing boards and health insurance plans, Medicare and Medicaid and state and federal managed care plans.
• Experience in credentialing processes and requirements (hospitals, health systems, medical groups, etc., state licensing boards, health insurance plans, Medicare and Medicaid, state and federal managed care plans
• Experience in navigating payer portals and directories
• Knowledge of CAQH Proview
• Baseline knowledge of revenue cycle management
• Ability to work within a deadline-intense environment
• Demonstrate problem-solving and customer service skills internally and externally
• Excellent verbal and written communication skills
• Excellent organizational and time management skills, ability to multi-task, and keep attention to detail is a must
• Highly resourceful self-learner, with the ability to operate effectively and independently
• Forward looking thinker, who actively seeks opportunities and purposes solutions
• Highly motivated and success-driven with the ability to implement and manage cross functional projects
• Willingness to pitch in and assist with other projects and share responsibilities as needed
• Ability to interact professionally and effectively with a variety of client types
• Strong presentation and client interaction skills

 

Your Qualifications:

• Master’s degree or equivalent experience preferred
• Minimum 2-5 years of consulting, credentialing, payer enrollment and state licensure experience within practice setting, hospital environment or health plan
• Proficiency with credentialing/enrollment software systems
• Strong organizational and excellent communication skills
• Strong proficiency with Microsoft Office (Outlook, Word, Excel, and PowerPoint), TEAMS, Credentialing/Enrollment software

All Career Openings