The posting
Summary To support the accuracy, compliance, and efficiency of the agency’s behavioral health systems and related processes. This role is responsible for maintaining provider credentialing and insurance contracting, ensuring accurate records, managing system administration and configuration, monitoring documentation and billing processes, and supporting users in resolving system and workflow issues. Essential Duties & Responsibilities
Work cross-functionally with other GESMV departments to maintain streamlined provider credentialing and insurance contracting processes and ensure accurate, current records are shared across departments. Maintain credentialing and revalidation for new and existing providers, ensuring records are accurate, complete, and current across all applicable systems, including Carelogic, GOSH, PNM, CAQH, and PECOS. Track the progress of provider credentialing applications and health plan contracts, proactively addressing outstanding items to ensure timely completion. Identify and resolve billing and system issues related to provider credentialing, insurance contracts, payer requirements, and system configuration by working collaboratively across departments and participating in relevant meetings. Ensure accuracy and completeness of ADAMHS applications and submit through the GOSH system. Run and review GOSH reports, update payer information in Carelogic, and identify and resolve outstanding application or span-date issues on a weekly basis. Monitor completion of required documentation and identify potential system configuration issues by reviewing reports, such as failed activities, failed claims, and activities without status reports, at least weekly. Process incoming record requests, ensuring proper documentation and adherence to all privacy standards. Maintain all aspects of user management within the EHR, including new employee setup, deactivation, permissions, and security. Maintain and implement system configuration changes, including activities, procedures, modifiers, fee matrices, payers, and other applicable system settings. Maintain and support integrated applications, including Dr. First, Client Engagement Suite (On Call), and other related platforms. Communicate system changes and relevant workflow impacts to end users and stakeholders. Monitor system functions and provide administrative and technical support to platform users.
Comply with all Agency policies, procedures, and safety standards throughout work areas and maintain same to meet CARF, HIPAA, Department of Labor, ODA, OOD, ODJFS, ODODD, ODMH, and other regulatory standards.
Complete other duties as assigned.
Supervisory Responsibilities
None
Education Requirements
Associate's degree in health information management, healthcare administration, information systems, or a related field required. Three years of directly related experience in EHR system administration, provider credentialing, insurance contracting, or medical billing may substitute for the degree.
Experience Requirements
Two (2) to three (3) years of experience in electronic health record (EHR) or health information system administration, including system configuration and user management, is preferred. Additional experience in provider credentialing, insurance contracting, or healthcare billing and claims resolution is desirable. Experience in behavioral health or Medicaid environments and familiarity with provider management systems, such as PNM, CAQH, or PECOS are also preferred.
Qualifications To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Employee must maintain a valid driver's license and a driving record acceptable to Goodwill's liability insurance provider. If at any time the employee is unable to maintain a valid driver’s license and a driving record acceptable to GESMV’s liability insurance provider, they must immediately notify Human Resources. Employee must use own vehicle for travel within the GESMV service area; must have and maintain a reliable source of transportation. Must maintain the ability to pass a criminal background check and random drug screens.
Skills & Abilities
Customer service oriented, with a pleasant disposition. Demonstrate initiative and flexibility while working independently with minimal direct supervision.
Ability to work cooperatively as a team member and collaborate with appropriate departments to support issue resolution. Ability to handle daily operational challenges with a calm demeanor. Possess excellent written and verbal communication, reading, and organizational skills, including the ability to communicate clearly with individuals who have varying levels of technical knowledge. Ability to prioritize and manage multiple tasks while following through on projects and assignments in a timely and efficient manner. Proficient in Microsoft Office applications. Strong attention to detail and commitment to maintaining accurate records and data. Ability to analyze information, identify discrepancies, troubleshoot issues, and determine appropriate resolutions. Knowledge of EHR systems, system administration, and configuration, or the ability to learn and adapt to new software applications. Understanding of provider credentialing, insurance contracting, payer requirements, and healthcare billing processes. Demonstrate uncompromising ethics and integrity; safeguard confidential information and protected health information in accordance with applicable privacy requirements.
Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform 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; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and talk or hear. The employee is occasionally required to climb or balance; stoop, kneel, crouch, or crawl; and taste or smell. The employee must regularly lift and/or move up to 10 pounds, frequently lift and/or move up to 25 pounds, and occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Work Environment The work environment 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 occasionally works in outside weather conditions The noise level is usually moderate
