CREDENTIALING NETWORK DEVELOPMENT SPECIALIST

The Network Development Specialist demonstrates excellent customer service performance in that his/her attitude and actions are always consistent with the standards contained in the Vision, Mission and Values of Covenant Health Care and the commitment to Extraordinary Care for Every Generation.

The primary role of the Network Development Specialist is to ensure that accurate data is collected, maintained, and reported for all providers of Covenant HealthCare Partners (CHP) PHO and Clinically Integrated Network (CIN). This position will be responsible for ensuring all provider rosters, internal and external, in the organization are valid and current with the most accurate data available. The Network Development Specialist will also be responsible for auditing information in the CHP credentialing software to ensure source of truth accuracy.

Database Management Systems Support

- Responsible for oversight of CHP provider rosters, both internal and external.

- Maintains internal provider database continuously and consistently to ensure that accurate and current information is available to all stakeholders.

- Audit, assess, implement, effectively utilize, and maintain provider database processes and information systems.

- Establish working relationships with all stakeholders.

- Evaluate the adequacy of the provider network to identify gaps in covered specialties and make recommendations to CHP leadership to help grow the provider network.

- Work with CHP credentialing staff, Covenant HealthCare's Central Billing Office and Medical Staff Office to ensure provider additions, deletions, and changes are shared and reconciled and that any updates are properly reflected in CHP rosters and credentialing software.

- Ensure discrepancies are addressed promptly and the proper follow-ups are completed in a timely manner.

- Serve as main point of contact for external queries regarding CHP provider roster and provider data.

- Organize information and data to identify/explain trends, problems, and their causes.

- Securely manage and maintain data integrity.

- Evaluate, analyze, and recommend software upgrades, changes, interfaces, and modules.

Payer Liaison/Enrollment/Termination Relations

- Work with payer partners and payer platforms provider data integrity, attestations, and annual audits.

- Responsible for CIN execution of participation agreement for newly approved providers.

- Responsible for collection of documents for physician payer enrollment in CHP contracts and disenrollment when physician terminates membership.

- Responsible for select payer patient discharges.

- Other duties as assigned.

EDUCATION/EXPERIENCE REQUIREMENTS

- Associate's degree in health services administration or business required. Bachelor's degree in health services administration or business preferred.

- Experience with electronic credentialing software, MD Staff or other credentialing software.

- Excellent computer knowledge and capability to use computer programs as required.

KNOWLEDGE/SKILLS/ABILITIES

- Achieve the process of change by recognizing and communicating the need.

- Express thoughts clearly, concisely, and effectively both verbally and in writing.

- Excellent communication, both written and verbal, and interpersonal skills.

- Ability to adapt behavior in response to new information or changing circumstances.

- Ability to work and collaborate effectively with others in unstructured or dynamic environments

- Understand information technology concepts, key functions, terminology, and work products.

- Knowledge of CAQH and NCQA.

- Understand current performance improvement concepts and ideas, such as setting goals, implementing systemic changes, measuring outcomes, and optimizing resources to meet the needs of the organization.

- Exhibit confidence and professional diplomacy while identifying, organize, facilitating and/or sustaining mutual beneficial partnerships with people of all levels internally as well as externally.

- Present in a confident, clear, and enthusiastic manner when addressing people in a small or large group.

- Inspire trust and confidence among stakeholders through reliability, authenticity, and accountability.

- Displays a credible presence and positive image when representing the organization.

- Excellent organization, time management skills and attention to detail.

- Commit to continuous performance and process improvement.

- Encourage and facilitate cooperation, trust, and group identity; and build commitment, team spirit, and strong relationships.

- Computer and word processing ability including MD Staff, Microsoft Office Suite (Word, Excel, PowerPoint, Teams).

- Demonstrates ability to maintain information in a confidential manner.

- Customer Service focused on all daily activities.

- Demonstrates ability to make sound independent decisions within boundaries of policies and procedures.

WORKING CONDITIONS/PHYSICAL DEMANDS

- Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards.

- Constant sitting.

- Frequent carrying, handling, tasting, and smelling.

- Frequent lifting 11-25 lbs.

- Occasional lifting 26-50 lbs.

- Occasional standing, walking, talking and hearing, pushing, pulling, stooping, kneeling, and squatting.

- Constant near vision, far vision, depth perception, color vision and field of vision.