Ruby Allison Email & Phone Number

Conduct all required duties as a network associate. Evaluate and negotiate contracts in compliance with company standard templates. Negotiate rate increases for providers, outpatient groups, FQHC’s and RHC’s. Prepare contract amendments for fee schedule increases and new state locations for providers, outpatient groups, FQHC and RHC’s. Participate in group acquisitions and mergers. Prepare contract amendments for FQHC billing changes. Submit DMR requests to update provider and group profiles for rate changes, demographic changes and networks. Run various Sure reports and submit intake request to create new fee schedules or modify existing fee schedules. Conduct outreach to potential providers and agencies. Establish and maintain strong business relations with providers and internal departments. Complete other duties as assigned by leadership.

Waltham, Massachusetts, United States

Recruitment of individual providers, for Optum Behavioral health. Recruitment of new outpatient groups with multiply providers. On boarding of a new group, collect and review all necessary data such as agency application, state license, malpractice, w9, JACHO or CARF certificates. Create and enter new group into Sales Force. Work with groups and credentialing department to gather any missing or requested information. Request site audits if necessary. Prepare weekly reports for internal and external meetings. Attend weekly onboarding meetings and new projects meeting.

Brighton, Ma

Verify with insurance companies that Physicians’ credentialing information is correct and current.Enter and update credentialing information within systems such as Athena, Intellicred and CAQH.Initiate enrollment process for physicians, physician assistants and nurse practitioners into different healthcare plans including Medicare and Medicaid. Attend weekly on boarding meetingsWith practice administrators, meet and review healthcare plan applications with physicians. Maintain tracking grids of all healthcare plans and current status of providers.

Prepares initial and recredential files for review by the Credentials Committee and Medical Executive monthly meetings. Manages expirables and tracks OPPE and FPPE information.Collects OPPE and FPPE information from chiefs, medical records and other departments. Creates score cards with OPPE and FPPE information and distributes to chief or chair of departments monthly. Responsible for verification of medical licenses, DEA, MCSR. Also verifies other medical staff affiliations, claim history, board certification, NPDB and OIG. Review and request board complaints and investigation of malpractice claims. Process and maintain all components of provider information database. Provides service to both internal and external customers. Coordinate and analyze all information needed to meet state regulations, JCAHO laws and NCQA guidelines. Also attends monthly Credentials Committee meeting and monthly general Medical staff meetings. Create and distribute committee approval letters for full, temporary and additional privilege, as well suspension and termination letters. Assists in the interview process and ordering of supplies for the office.

Greater Boston Area

Verify with insurance companies that Physicians’ credentialing information is correct and current.Enter and update credentialing information within systems such as Athena, Intellicred and CAQH.Initiate enrollment process for physicians, physician assistants and nurse practitioners into different healthcare plans including Medicare and Medicaid. Attend weekly on boarding meetingsWith practice administrators, meet and review healthcare plan applications with physicians. Maintain tracking grids of all healthcare plans and current status of providers.

Greater Boston Area

Manages credentials for Cambridge Health Alliance, prepares files for review by the Credentials Committee and Medical Executive monthly meetings. Responsible for verification of medical licenses, DEA,MCSR. Also verifications of medical education, claim history, board certification, NPDB and OIG. Review and request board complaints and investigation of malpractice claims. Ensure accuracy and Integrity of all physician information. Process and maintain all components of provider information database, initial applicants and re-appointments. Provides service to both internal and external customers. Coordinate and analyze all information needed to meet state regulations, JCAHO laws and NCQA guidelines.

Greater Boston Area

Manages patient flow for clinicians to optimize patient appointment availability. Determines urgency and priority of walk in and add on patients, patient consults, etc. Manages clinicians daily schedules to expedite care and maximize clinical time. Coordinates the practice when clinicians are not available, ensuring that telephone calls are triaged appropriately and clinicians receive necessary information. Monitors practice issues and problems, indentifies and solves concerns regarding patient satisfaction, patient flow, and compliance with procedures and guidelines. Assists in resolving patients’ concerns. Identifies and assists in resolving operational Difficulties and communicates with supervisor regarding unit issues and problems necessary. Provides coverage and support for supervisor, as assigned. Provides input to supervisor in hiring of new support staff, and informs the supervisor of outstanding issues in the practice. Assists with data collection activities for statistical reports or required studies, ensuring data is properly collected and accurate. Completes paperwork to obtain information from or provide information to outside doctors, hospitals, health or social service agencies. Participates in special projects and ongoing programs unique to the department. Assists with orienting new staff as well provides back up coverage for other support staff as necessary.

Greater Boston Area

Responsible for verification of medical licenses, DEA, MCSR. Also verifications of medical education, claim history, board certification and OIG. Review and request board complaints and investigation of malpractice claims. Ensure accuracy and Integrity of all physician information. Process and maintain all components of provider information database, initial applicants and re-appointments. As well allied health professionals. Process and maintains all delegated credentialed provider information. Ensures accuracy of contracts between providers and health plans. Provides service to both internal and external customers. Coordinate and analyze all information needed to meet state regulations, JCAHO laws and NCQA guidelines.

Watertown, Ma

Responsible for verification of medical licenses and investigation of malpractice claims for over 2,500 physicians. Ensure accuracy and Integrity of all physician information. Process and maintain all components of provider information database. Provider service to both internal and external customers. Coordinate and analyze all information needed to meet state regulations. Prepare and design queries and reports for management.

Watertown, Ma

Assisting members with billing inquiries, updating member information, referrals and pre-registration. Investigating and adjusting claims, member reimbursements, and provider statement of accounts.

Business Administration And Management, General

Diploma

Health/Health Care Administration/Management & Business Administration