Senior Health Care Consultant

The Health Care department of one of the fastest-growing accounting firms in the country is seeking a Senior Health Care Consultant who is motivated to learn, excited to collaborate and passionate about delivering outstanding results. 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. 

This role is responsible for end-to-end management and completion of initial complex client enrollment projects for providers/facilities 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. The Senior Health Care Consultant is responsible for the review and 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 peers, 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 Senior Health Care Consultant must deliver exceptional client service, which is an expectation representing Anders vision, mission, and core values.

 

What You’ll Do:  

• 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 or delegate the 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 or delegate the hospital medical staff applications for initial appointments reappointments, If delegate to a co-worker, reviews application for accuracy prior to submission to the credentialing entity.
• 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
• Delegates the process to create and maintain CAQH provider profiles for new and existing providers on an ongoing basis. Review profiles for errors and correct accordingly to co-worker; completes a thorough review to ensure accuracy
• 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 the 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
• 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; Provides appropriate feedback to the client
• Provide end user education and training on software applications and assist with developing training materials
• Plays an active role in software integration
• Assesses implementation project goals, plans, issues, timelines and action items
• Liaison between software vendor and internal technology to identify security or platform needs.
• Documents work hours appropriately in CCH daily
• Notifies Health Care Practice Leaders of potential concerns outside of employee’s scope of responsibility
• Notifies Health Care Practice Leaders of additional client request for services outside the scope of their current engagement
• 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 Care Services staff meetings, ancillary and firm meetings
• Senior Health Care Consultant maintains knowledge of all Anders services for cross-selling opportunities
• Responsible creating a blog related to current health care trends at least twice per year.

What We’re Looking For:   

• Proficiency working in various credentialing/enrollment software systems
• Strong organizational and excellent communication skills
• Strong proficiency with Microsoft Office (Outlook, Word, Excel, and PowerPoint), TEAMS, Credentialing/Enrollment software
• Strong problem-solving, attention to detail, project management
• Excellent written and verbal communication skills
• Ability to interact effectively with a variety of people internal and external
• Ability and willingness to travel in and out of state as necessary
• Ability to perform well under pressure, adapt to change, and meet deadlines in a fast-paced environment

Your Qualifications:  

• Masters degree or equivalent experience preferred
• Minimum 3-5 years of consulting, credentialing, payer enrollment and state licensure experience within practice setting, hospital environment or health plan

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