Marisol Quesada Email & Phone Number

• Assist in service provider proposal review and negotiations with new contract service agencies• Assist in the coordination of written contract service agreements• Monitor contract provider’s adherence to contractual obligations• Maintain an ongoing and professional relationship with contract providers• Provide technical assistance to contract providers, including authorization process, development of clean claims, provision of services, and coordination within organization to… Show more • Assist in service provider proposal review and negotiations with new contract service agencies• Assist in the coordination of written contract service agreements• Monitor contract provider’s adherence to contractual obligations• Maintain an ongoing and professional relationship with contract providers• Provide technical assistance to contract providers, including authorization process, development of clean claims, provision of services, and coordination within organization to obtain answers to inquiries• Assist in monitoring compliance of the contract provider with current Federal, State and County policies and/or regulations working with providers to ensure compliance• Function as liaison between organization and the contract provider to facilitate negotiation of provider contracts• Ensure contract provider compliance with training and orientation to organization regarding contract requirements and policies and procedures• Assist in the collection of data for contract compliance activities, including record reviews, contact with network providers, and collaboration within administration• Prepare and facilitate quarterly provider meetings for multiple service lines Show less

• Build and maintain positive relationships with Providers, ensuring they are well informed of contract requirements, new policies or processes, status of claims reviews and all related deadlines• Inform Providers of contract compliance through conducting orientations and re-orientations• Work with the Provider Relations department to prepare and hold regularly scheduled Provider Meetings and the Provider Advisory Group Meetings• Support and assist other internal teams with other… Show more • Build and maintain positive relationships with Providers, ensuring they are well informed of contract requirements, new policies or processes, status of claims reviews and all related deadlines• Inform Providers of contract compliance through conducting orientations and re-orientations• Work with the Provider Relations department to prepare and hold regularly scheduled Provider Meetings and the Provider Advisory Group Meetings• Support and assist other internal teams with other Provider communications, meetings or trainings as needed to maintain positive internal relationships• Troubleshoot claim, benefit and eligibility, including in-depth review of Explanation of Benefits, claims verifications and completion of Provider reconciliations per department process• Perform provider site visits to maintain positive working relationships• Maintain effective communication and a collaborative work-style with contracted Providers and internal departments at BHPI Show less

• Oversee re-credentialing of providers• Coordinate contracting and amendment initiatives• Coordinate report development and completion according to contractual requirements or ad-hoc requests• Coordinate mass mailings to communicate contract changes, meeting notices and miscellaneous notifications • Regularly review and update departmental policies• Serve as initial point of contact for all questions and inquiries from internal and external sources• Deal with issue… Show more • Oversee re-credentialing of providers• Coordinate contracting and amendment initiatives• Coordinate report development and completion according to contractual requirements or ad-hoc requests• Coordinate mass mailings to communicate contract changes, meeting notices and miscellaneous notifications • Regularly review and update departmental policies• Serve as initial point of contact for all questions and inquiries from internal and external sources• Deal with issue resolution and complex trouble shooting for providers• Train new department staff and collaborate with other areas to ensure training of current staff in new procedures• Maintain provider database and train staff on database and changes• Perform administrative provider site visits to maintain positive working relationships• Perform and coordinate special projects Show less

• Maintain accurate and complete Provider files and database in accordance with contract requirements• Work cohesively with Providers to collect information and keep current records in accordance with departmental expectations

• Assist in the development of processes and procedures• Develop filing system• Schedule Site Visits and Environmental Surveys• Coordinate meetings with Recipient Rights Advisors of external agencies• Develop and maintain logs for incident reports and rights complaints• Various clerical duties