Payer Relations Onboarding & Transitions Specialist

U.S. Oral Surgery Management 

500 E John W Carpenter Fwy #300, Irving, TX 75062

Position Summary: The Onboarding and Transition Specialist plays a pivotal role in new practice transition and surgeon onboarding. The Specialist partners closely with Operations, Recruitment, Revenue Cycle, and Transition teams to ensure an exceptional partner experience and adoption of USOSM/Payer Relations best practices.

Measures of Success:  Supports Payer Relations Transition process through timely and effective transition of credentialing functions. Plays critical role in Surgeon Onboarding via execution, monitoring, and communication of onboarding items (licensure, hospital, malpractice insurance). Serves as the primary liaison to USOSM Recruiting and Transition teams.

Primary Duties:

1. Positively impacts partner practices and coworkers. Continues to grow and improve
2. Proactively communicates with practice partners, associate/partner surgeons, and other stakeholders
3. Supports end-to-end Payer Relations surgeon onboarding and offboarding process
   • Communicates timely and effectively with incoming surgeons and stakeholders
   • Builds initial surgeon file, creates provider profile in credentialing software
   • Handles licensure applications, updates including DDS, MD, DEA, CDS/CSR
   • Facilitates initial malpractice insurance applications and/or transfer of COI to new partner practice. Reviews loss -run data for malpractice history and secures narratives and documentation as needed  
   • Attends all surgeon- and practice-facing onboarding calls, ensuring timely updates to attendee of onboarding status or potential delays. Escalates issues to supervisor and Recruiting team as necessary
   • Drafts, submits, and monitors all hospital privilege applications
   • Updates NPI profiles as necessary

4. Facilitates New Partner Practice Payer Relations Transition

• • Serves as primary liaison between Payer Relations and Transition Team, practice leader, and assigned Region Operations Director
  • Attends initial Weekly Practice Partnership call to provide intro to Payer Relations function, overview transition timing
  • Attends weekly internal Partnership Transition call to prepare for new partner practices and other related meetings as needed
  • Leads Practice Payer Relations transition call, including expected deliverables and timeline
  • Builds new partner practice and surgeon profiles in credentialing software. Coordinates with Payer Specialist to ensure their accurate build of contracted plans.
  • Maintains and distributes monthly practice/provider roster to stakeholders. Shares recipient feedback with Payer Relations team as needed.
  • Monitors diligence documents provided pre-partnership and downloads and saves diligence documents and data from data room to appropriate Payer Relations folders on share drive.

5. Provides for Denovo/Facilities support

• Serves as primary liaison to Facilities & Real Estate team to ensure timely notification of new locations, relocations, and closures.
• Facilitates updated/new/revised licensure associated with facilities plans
• Relays, where applicable, payer enrollment changes to Payer Relations team to ensure payer profiles are accurate and reflect new or updated location information
• Attends standing and ad-hoc meetings as needed to ensure proper line of sight to upcoming plans and preparation

6. General

• • Documents all progress/notes in credentialing software and Zendesk, per standard operating procedures
  • Serves as backup for Credentialing Specialist-Generalist as needed. Supports special projects as directed.
  • Responds to phone and email inquiries timely or forwards to appropriate team member
  • Ensures doctor/practice payer files are complete and accurate
  • Works with credentialing software vendor as necessary to report technical issues, request enhancements and workflow tools.

7. Works collaboratively with others and serves as a mentor to new employees. Follows the USOSM POWER model.

8. Other duties as assigned.

Competencies:

Must be able to speak, read, and write fluent English.

Exceptional human relation skills

Ability to manage multiple priorities with interruptions

Ability to work with people of all ages

Ability to use correct grammar, spelling, and punctuation

Ability to always maintain professional demeanor

Ability to understand the dynamic, changing insurance industry

Ability to resolve conflict

Ability to complete tasks within the required time frame

Ability to write legibly and clearly

Compliance with all federal, state, and local regulatory laws and licensing requirements

USOSM (and its affiliates) is an equal opportunity employer and do not discriminate on the basis of race, color, gender, religion, age, sexual orientation, national or ethnic origin, disability, marital status, veteran status, or any other occupationally irrelevant criteria.  All locations are smoke-free environments and as such, prohibit smoking in all facilities.  This is a drug-free workplace.  Employment is on an “at-will” basis and is for no definite period and may, regardless of the date or method of payment of wages and salary, be terminated at any time with and without cause.  No person, irrespective of title or position, has authority to alter the at-will status of your employment or to enter into any employment contract for a definite period of time with you.