Naomi Sanchez Email and Phone Number

This position is accountable for providing support to Network Data Management and all departments utilizing provider date including the screening of provider loading, as well as coordinating all procedural aspects relative to the NovaWell provider systems. This position is also responsible for handling important or sensitive projects and priorities that require a high degree of attention and performing other duties as assigned by management.Responsibilities:• Assists with the direction and supervision activities of the Provider File Area to ensure the accurate, complete and timely maintenance of the NovaWell provider data files.• Resolve provider data errors by identifying causation and recommend improvements, identifying strengths and documenting best practices. Investigates all incidents impacting the data integrity and programs to allow for analysis of trends and potential vulnerability.• Assist in the preparation, development and analysis of specifications for system enhancements and modifications to ensure provider files integrate properly with current and planned systems.• Produces and develops specifications and user testing criteria while securing appropriate documentation to assure accurate data in file.• Evaluate and recommend improvements to specific current operating procedures to enhance operating efficiencies and controls.• Handle important or sensitive projects and priorities that require a high degree of attention.• Produce departmental reporting for quality and production, including vendor audits.• Provide departmental representation on workgroups and committees.

• Enforce regulatory compliance and quality assurance• Prepare and maintain reports of credentialing activities such as accreditation, membership or facility privileges• Ensure that all information meets legal, federal and state guidelines when processing applications• Responsible for carrying out various credentialing processes in relation to physicians and allied health practitioners• Process applications for initials applicants as well as reappointments (approximately 125-200 quarterly)• Collect and process significant amounts of verification and accreditation information• Maintain and update accurate information in the Echo database (includes education, training, experience, licensure) Prepare material for Credentials Committee meeting, MEC as well as Board of Trustees meeting Sets up and maintains provider information in Echo Maintains confidentiality of provider information• Ensure compliance with the Bylaws at each location as it pertains to the credentialing process Schedule, and on occasion attend and take minutes for site based medical staff department meetings Process and collect dues for the site based medical staff• Compiles and maintains current and accurate data for all providers• Sets up and maintains provider information in online credentialing database• Tracks license and certification expirations for all providers• Maintains confidentiality of provider

1. Manages Athena enrollment tasks dashboard to ensure provider/department/facility data is accurate and complete2. Knowledgeable of payer enrollment policies and updates internal documents and checklists according to department guidelines3. Works closely with managers, providers and clinical staff to obtain and verify the documentation and signatures necessary to process Medicare initial enrollments, Revalidations, and initial Medicaid non-billing enrollments4. Assists to complete initial credentialing applications for new facility enrollment, and supplies supporting documentation as required by commercial and government payers5. Performs assigned tasks required to maintain the timelines for enrollment schedules and ensure documentation is updated and submitted as required to avoid a disruption in participating status and revenue6. Audits provider rosters and payer directories. Provides updated provider files to the payers ensure payer files are accurate and current7. Follow up with all payers to ensure enrollment documentation is received and updated in a timely manner8. Assists to coordinate enrollment data and other accreditations with the Credentialing Department.9. Assists in researching claim denials and trends related to enrollment and billing10. Follows-up with payers to resolve the billing issues related to enrollment and ensure claims are reprocessed for payment as payer systems are updated11. Responds to internal and external inquiries on routine enrollment and privileging matters12. Maintains a strict level of confidentiality for all matters pertaining to provider enrollment13. Performs other duties as requested

1. Responsible for the timely preparation, submission and tracking of monthly and ad-hoc delegated rosters and government enrollment materials. Follows up with plan regarding outstanding and incomplete rosters. Upon receipt of completed files and rosters, verifies correct loading and audits demographic/contractual data elements. Distributes status reports/updates internally and to departmental and CDIS stakeholders for accurate and timely updating of databases, credentialing grids, dictionaries, portals and websites. 2. Coordinate special credentialing, enrollment and operational projects, including large scale FPO wide projects such as a Tax ID Consolidation, new payer/product offering roll-outs and the centralization of additional enrollment/credentialing functions. 3. Complete comprehensive Roster Reconciliations to ensure Payer and PEG records accurately reflect participation status, valid demographics and linkage. 4. Complete Annual/Quarterly Payer audits, compliance and reporting activities. 5. Primary point of contacts for payers; hold regular meetings to discuss enrollment, credentialing and linkage; provides issue status and resolution to interested parties; escalates issues as needed. 6. Establish and maintain positive relationships with key FPO administrators and representatives. 7. Report out on payer enrollment/participation statistics at departmental meetings and as requested. Generate monthly PEG Secure Server reports and ad-hoc reports as requested. 8. Execute quality assurance activities, including but not limited to overseeing verification initiatives, auditing of data entry, generating and analyzing Compliance Reports and executing clean-up projects. 9. Special projects and cross coverage as needed.

• Perform primary provider source verifications of license, Drug Enforcement Administration (DEA) number, hospital affiliation, board certification status, malpractice history and sanction activity through various web-based agencies and sources• Research and summarize provider’s malpractice history for Credentialing Committee review• Enter and review provider information in Trinity system; prepare reports as needed• Confirm authenticity of documents and ensure pre-established criteria has been met; return provider applications that do not meet criteria• Verify and review provider applications, participation agreements or designations of provider groups for completion• Follow up with providers or office managers in regards to missing or expired information in the credentialing application or documentation• Check provider status files for duplication and possible conflicting information• Perform statistical analysis via Excel spreadsheet• Perform additional duties and projects as assigned by management

• Data enter credentialing information (i.e. provider applications, correspondence, spreadsheets and provider file folders) accurately and efficiently, as well as identify discrepancies that prevent a field from being data entered• Provide clerical support including but not limited to filing, copying, faxing, collating and scanning, inclusive of uploading scanned images into the Credentialing database• Create, prepare and collate mailings to providers using Microsoft Office• Research, confirm and print provider information from external websites• Retrieve and file provider profiles, correspondence, etc• Respond to inquiries, (telephonic or through other methods of communication) regarding receipt status of a provider file or the retrieval of a provider file• Update spreadsheets concerning approved and delegated providers• Review and confirm providers are terminated from various provider systems to purge closed files and prepare for on and off-site storage• Update various provider and credentialing reports• Perform additional duties and projects as assigned by management

• Cordially greet and direct patients to appropriate area when needed• Operate a telephone call directory, multi-line phone • Collect, retrieve and accurately input patient’s demographic, financial and insurance information at time of registration.• Check records for accuracy of information and for conformity with established policy and procedures • Use of different health insurances websites for the correct verification and collecting of information• Collect co-payments at time of registration when required• Obtain authorization and referrals for different specialty visits when required • Closing cases according to services rendered• Furnish information and prepare reports requiring the selection of data from simple records or statistics

• Responsible for work flow in an emergency department area of patient registration• Collect consent for treatment and other forms for patient’s medical chart• Gathering, reviewing and entering patient demographic and insurance information• Scan in all documents in medical document management software• Transfer and admit patients within the hospital using medical software• Direct patients to appropriate departments• Manage difficult or emotional situations with patients and family member