Kayla Pearson Email and Phone Number

*Perform audits of provider setup within the provider information system to ensure accurate contract implementation and subsequent claims processing* Review and price contract related pends to ensure claims payment accuracy*Ensure accure contract implementation and subsequent claims processing through provider setup, UAT testing, etc. on basic Change Requests (i.e. RHCs/FQHCs/fee schedule updates)*Troubleshoot and problem solve contract implementation issues related to basic system configuration*Review contracts and assign pay classes and applicable provider information based on contract language. If configuration is needed to accommodate a contract, notify the appropriate parties*Assist with the internal communication of all new and revised material contract terms and provisions to all affected departments*Review new and current provider contracts and establish state guidelines*Participate in determining the appropriate configuration of the claims payment process in the appropriate subsystem of the claims payment information system in conjunction with health plan, claims and corporate management and information systems staff

Develop and maintain effective credentialing contacts at insurance companies, hospitals and regulatory agenciesProcess credentialing and re-credentialing applications for all physicians, advanced practice professionals as well as physical/occupational therapists and locums. Work closely with providers, insurance companies, and hospitals to ensure timely completion of applicationsMonitor completion of credentialing and re-credentialing process, communicate status of credentialing process to clinical and billing departments as necessaryMonitor accuracy of credentialing information on insurance company provider directories and other sourcesAssist Business Services with claims resolution related to credentialing issues as necessaryCoordinate process for providers to obtain malpractice insurance. Provide current malpractice insurance information to insurance companies and others as neededMonitor expiration dates of state licensure, federal controlled substances certification, state controlled substance certification and board expiration, maintain reminder system for providers as expiration dates approach Maintain current, accurate personal, malpractice and licensure information for all providers in individual credentialing files as well as clinic wide directories Respond to questions from providers, insurance companies and hospitals regarding credentialing, licensure and malpractice insuranceMaintain a record of Continuing Medical Education for providers upon requestMaintain strictest confidentialityKnowledge, use and development of organizational policies and proceduresKnowledge and use of medical office management and/or health insurance industry practices

Assist the Executive Director of Regional Operations, Executive Director of Facilities Maintenance and Medical Directors with coordinating projects, writing reports, and special needs while meeting required deadlines.Create and maintain quarterly statistical databases for Family Medicine and Network providers' patient counts, revenue and production, FTE ratios, benchmarking data, present results to Medical Directors, Executive Director of Regional Operations and Family Medicine & Network Providers.Assist with various Lean projects throughout McFarland Clinic to enhance patient flow, patient registration, and the patient referral process, while assisting with establishing new processes.Audit McFarland Clinic's Scheduling Systems (McKesson & Epic) for HIPAA purposes.Work with department directors and train staff to maintain building security using the P2000 security system, while establishing protocols for locking/unlocking buildings and determining the standards for 24/7 access.Maintain Capital Project records for the Executive Director of Facilities Maintenance.Maintain lease information for all McFarland Clinic owned and leased buildings.Schedule and coordinate meetings and appointments for Executive Director of Regional Operations and Executive Director of Facilities Maintenance.Schedule and coordinate meetings and appointments for Medical Directors' administrative meetings with Regional Operations departments. Prepare materials and provide reports as requested.Act as a resource and support system for network office managers, network staff and providers.Assimilate materials and supplies for network office set-ups and manager orientations.Compose, format, and print business correspondence; memos and letters for Regional Operations and Facilities Maintenance.