Just a few of the Benefits enjoyed by PPIL employees…
-Company subsidized premiums on Medical, Dental, and Vision Insurance
-Up to 12 weeks Paid Parental Leave for eligible employees
-Generous Paid Time Off (PTO) and paid holidays
-Mission focused work
-401k with employer matching
-100% company-paid Life Insurance
-100% company-paid Short and Long Term Disability Coverage
-Robust Employee Assistance Program
-Professional Development awards and opportunities
-Flexible Spending Accounts
-Free Medical Services at PPIL
-Pet Insurance
All staff at Planned Parenthood of Illinois are required to be fully vaccinated against COVID-19. Planned Parenthood of Illinois is an equal opportunity employer and reasonable accommodations will be provided based on religious beliefs and to those with disabilities.
Payer Relations Coordinator
The Payer Relations Coordinator is responsible for (1) maintenance and coordination of the Payer Contracts and implementation of its accuracy in revenue generating business areas. (2) Facilitating provider credentialing, re-credentialing and privileging processes, and (3) supporting effective denials management through payer contract file and fee maintenance. This position serves as a Credentialing and Contracting support resource for the Revenue Cycle Team.
Essential Functions:
The Coordinator serves as the administrative liaison for Planned Parenthood Revenue Cycle Payer Contracting and Credentialing. This Coordinator maintains the admin files to help ensure that providers are credentialed with all PPIL patient health plans, ensures that all licenses are current for providers, and ensures that fee schedules and rates are maintained and up to date for all providers and health plans. Through this role, the Coordinator has the opportunity to ensure state, federal, payer and internal billing system accuracy to reduce Revenue Loss.
Payer Contracting (70%)
1. Responsible for the administrative maintenance of the Payer Contracts files and Fee Schedules for the Revenue Cycle Team to provide accurate information and estimates to patients.
2. Responsible for the admin task of the PPIL’s Contracting/and renewal application processes with all PPIL payers.
3. Maintains and follows up on the Contract status of applications with payers and internal staff, tracking progress on all pending applications, and communicating timely accurate result to RCM Team members.
4. Researches Billing rules, Regulations and Pricing. Audits Billing to ensure Daily automated contractual adjustment accuracy on all patient claims.
5. In Collaboration with System, Ensures the accuracy of all Payer Contractual Rates, Fee Schedules and Contracting info in all PPIL Databases.
6. Attends all payer Relations calls and submits accurate payer plan information to the RCM Verifications team to assist with prior authorizations and health plan benefit determinations.
7. Supports Revenue Cycle in the resolution of denials and payer issues utilizing the Payer contracts, fee schedule.
Credentialing (30%)
8. Responsible for the admin task of the PPIL’s enrollment and credentialing/re-credentialing application processes with all PPIL payers, and also reviews, maintains, and follows up on the status of applications with payers, tracking the progress on all pending applications, and communicating results.
Maintain up-to-date data for each provider with each plan to assure that PPIL's provider credentialing is complete
Ensure timely renewal of licenses and certifications
Process initial credentialing and enrollment applications to meet all plan requirements.
Responsible for the RCM Interdepartmental collaboration to ensure routine internal collection of the necessary data and signatures required for credentialing
Maintain PPIL's credentialing data files (current state licenses, DEA & CDS certificates, malpractice coverage and any other required credentialing documents) and participate in audits as requested
Process and facilitate provider re-enrollment to ensure seamless maintenance of provider status and prevent claims denials for credentialing and enrollment reasons
Communicate payer training needs to providers annually; collaborate with RQM and MST on monitoring compliance with required payer trainings
Maintain knowledge of current health plan and agency requirements for credentialing providers
Schedule monthly meetings with all payers to ensure accurate registries and claims payments
Respond to credentialing and license inquiries from clinical operations and revenue cycle teams; work with revenue cycle staff to resolve payment issues and reduce claim denials
Create and explain job aids and provide educational support as appropriate and requested
20. Responsible for maintaining the accuracy of the CAQH, IMPACT and Internal Credentialing databases.
21. Demonstrate an understanding of and commitment to PPIL core values of access, activism, care, confidentiality, diversity, excellence, integrity, respect, self-determination, and stewardship; practice these values in relations with internal and external customers
22. Perform other duties as assigned
Supervisor: Director of Payer Relations and Revenue Cycle Management
Status: Full-time. Non-exempt from the overtime provisions of the wage and salary regulations.
Physical Demands:
The physical demand characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to stand, walk, talk, read, see and hear. The employee is frequently required to use hands and fingers to type, handle, or feel and reach. The employee is regularly required to sit. The employee must occasionally lift and/or move up to 25 pounds
Education and Qualifications:
Associates Degree or equivalent combination of experience and education preferred. High School Diploma or GED Required. Strong knowledge of Commercial, Illinois Medicaid/MCO Insurances Contract Research and Insurance Fee Schedule Pricing technical Knowledge is required. Minimum of 2 years of relevant healthcare physician practice contracting and credentialing experience utilizing CAQH and IMPACT databases is required. Ability to demonstrate working knowledge of health care Billing and denials processes, including a thorough understanding of physician practice medical insurance carrier policies and procedures required. Technology skills must include expertise in use of spreadsheet software and electronic records systems. Project management and database management skills desired.
Professional Qualities:
The Coordinator is a proactive problem-solver with strong analytic and interpersonal skills that possesses:
Excellent follow-through and attention to detail
Ability to proactively prioritize and attend to detail
Excellent interpersonal relationship management skills
Strong communication, written and oral, and excellent organizational skills
Ability to work under pressure and meet stringent deadlines, in a fast-paced environment
Commitment to maintaining confidential information
The Coordinator must demonstrate a commitment to the mission and operating goals of Planned Parenthood of Illinois.
Planned Parenthood works affirmatively to include diversity among its workforce and does not discriminate in the selection of its staff based on factors including but not limited to race, color, religion, sex, national origin, age, sexual orientation, gender identity, disability, income, marital status or any other characteristic protected under federal, state or local law. We encourage diverse candidates to apply for this position.
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