**Location:** Avera Health **Worker Type:** Regular **Work Shift:** Day Shift (United States of America) **Pay Range:** _The pay range for this position is listed below. Actual pay rate dependent upon experience._ $21.75 - $29.00 **Position Highlights** *Must be located within an Avera Health region* **You Belong at Avera** **Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.** **A Brief Overview** Responsible for coordinating the day-to-day workflow of the Avera Health managed care contracting and delegated credentialing process. This role is accountable for management of the complex system-wide provider information/data within the Avera contracts and credentialing database. This role will ensure timely and accurate submission of practitioner, ancillary and facility credentialing data to payers to ensure accurate payer databases, contracts and directories. This role is responsible for analyzing and reviewing proposals, overseeing large databases, and supporting the provider delegating credentialing process. The Provider Contracting Operations Coordinator will serve as a liaison between Avera sites, billing departments and the managed care organizations to discuss trends, issues, and areas of opportunity. ​​The Provider Contracting Operations Coordinator is a professional leader and integral member of the Payor Contracting team; which provides exceptional service to the Avera System providers, facilities and contracted payors. The Provider Contracting Operations Coordinator recommends and fosters opportunities for enhancing collaborative relationships with payors and providers and improving the overall productivity and efficiency of the department. **What you will do** + Coordinate and maintain the Avera system payor contracts and amendments for Avera sites by creating and maintaining a comprehensive database and reporting mechanism. Oversee contracts through their life cycle and ensure contract renewals or terminations occur within established timeframes. + Leads the new provider enrollment process for commercial payers and managed government payers. Keeps sites apprised of status of credentialing, announcements to payers and managed the timeline for release of claims with the business office. + Manages Avera practitioner contracting database for provider and facility demographic change, terminations and updates. Creates queries and reports to analyze and communicate with payers for contractual obligations, escalated issues and supports mandatory reporting for compliance requirements. + Manages the delegated credentialing relationship with payers by contract analysis and execution, implementation. Executes queries and reports, policies and procedures and audit samples for compliance with regulatory and accreditation purposes. Serves as liaison for system in review of best practices, standards and data reporting requirements, manages, and implements any follow-up policy changes and reporting. + Reviews, analyzes and escalates claim denials and processing issues according to contract and payer policies. Draws conclusions and develops strategies to resolve contract issues in a timely fashion. Communicates directly with payor and Avera leadership regarding resolution. + Develop, deploy and lead system wide education for Avera system contracting and credentialing processes and procedures. Discerns and develops regular payer updates to stakeholders, sponsors and team members at all levels regarding changes to payer contracts, programs and credentialing. + Implements and leads new site implementation with payers for managed care enrollment, new site setup, and contracting and communicates with stakeholders during implementation phase. + Prepares reports to communicate with payers bi-weekly on new providers and sites, changes and termination. Analyzes and updates the monthly reappointments with timely submission and follow-up with Avera sites, practitioners and facilities. + Supports continuous improvement efforts, including process redesign and technology implementation, as well as communication with stakeholders regarding best practices with payer policies, credentialing data exchange and reappointment process. **Essential Qualifications** The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer. **Required Education, License/Certification, or Work Experience:** + Associate's Education in health administration, health information management, business, accounting, or information services or 5 or more years related experience and/or training; or an equivalent combination of education and experience. **Expectations and Standards** + Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community. + Promote Avera’s values of compassion, hospitality, and stewardship. + Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity. + Maintain confidentiality. + Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment. + Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable. **Benefits You Need & Then Some** Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future. + PTO front-loaded for eligible hires + Free health insurance options, for full-time single coverage on Avera High Deductible Health Plan + Up to 5% employer matching contribution for retirement + Career development guided by hands-on training and mentorship _Applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to_ _talent@avera.org_ _._ At Avera, the way you are treated as an employee translates into the compassionate care you deliver to patients and team members. Because we consider health care a ministry, you can live out your faith, uphold the dignity and respect of all persons while not compromising high-quality services. Join us in making a positive impact on moving health forward. The policy of Avera to provide opportunities for all qualified employees or applicants without regard to disability and to provide reasonable accommodations for all employees or applicants who may be disabled. Avera is committed to ensuring compliance in accordance with the Americans with Disability Act. For assistance, please contact HR Now at 605-504-4444. Additional Notices: For TTY, dial 711 Avera is an Equal Opportunity/Affirmative Action Employer: Minority/Female/Disabled/Veteran/Sexual Orientation/Gender Identity.