Provider Network and Operations Coordinator - Hybrid

Employment Type:Full timeShift:Day ShiftDescription:WHO WE ARE

Mercy One Population Health Services Organization (PHSO) is a clinically integrated network comprised of independent, owned, and managed affiliates. The Provider Network team is responsible for building and maintaining a robust network of high-quality partnered providers. We manage provider relationships, contracting, and the preferred payer agreements.

Additionally, we serve as a critical link between our providers and preferred payers, advocating on behalf of the network by escalating concerns, including claims-related issues, and following them through to effective resolution.

This hybrid role works in office twice a week once trained and is an integral team member of Mercy One PHSO’s Operations team, the Provider Network and Operations Coordinator assists PHSO leadership on tasks as assigned. Functions including oversight and management for the Mercy One Provider Network Directory, Compliance & auditing, and coordination of projects. Serves as a liaison between PHSO administration, Chapters, regulatory bodies, and Mercy One Partnered Provider organizations/providers as needed.

This role is part of the Mercy One PHSO Operations team, reporting to the Provider Network Supervisor.

1. Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.

2. Provider Network Support

• Serves as the key resource to implement andmaintainan accurate, NCQA-compliant Provider Network Directory.
• Develops andmaintainsintake/assessment forms to gather key information to support the Provider Network Directory.
• Coordinates with Medical Staff Offices, Physician Recruitment and Employment, and Clinic Managers to obtain all required information as part of recruitment processes.
• Assistsin the management of PHSO Participant Agreements and Network Contracting.
• Assistsin the investigation and response to member inquiries related to the Provider Network and Directory.

3. Compliance Support

• Manages andmonitorselectronic Policy and Procedurehandbook.
• Completes documentation and useraudits according to federal and state health statutes, as well as third party control provisions.
• Assists the ACO Compliance Officialin evaluating and responding to inquiries from governing bodies/regulatory agencies (i.e.: CHAN, Centers for Medicare and Medicaid Services)
• Assistsin theon-boarding of new ACO Participantsand Providers.
• Responds to PHSO email and phone inquiries from patients,providers and regulatory bodies.

4. Project& Meeting Support

• Assists with agenda creation, presentation of materials, and minutes for key meetings, including Provider Network Council and Chapter Governance Meetings.
• AssistsPHSO leadership with special projects, including the tracking of deliverables, compiling information and reports, etc.
• Acts asresourcein various committees and meetings to coordinate changes in ACO processes.
• Maintains PHSO directories, websites, and Sharepointsites with education content.

5. Other duties as needed and assigned by the manager.

6. Maintains a working knowledge of applicable Federal, State, and local laws and regulations, Trinity Health’s Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

1.Bachelor’s degree preferred. In lieu of educational requirements,previous work history and years of experience may be considered.

2. Minimum ofone year of experience with a healthcare system, healthplanor healthcare accrediting body. Prior experience inproject coordination preferred.

3. Experience in ACOs and knowledge of…