Henry Ford Health · 3 weeks ago
Network Payor Relations & Compliance Specialist (Hybrid - Jackson, MI) - Mosaic CIN
Jackson, MI
Full-time
Hybrid
Entry Level
2+ years expHenry Ford Health is seeking a Network Payor Relations & Compliance Specialist to join their Mosaic Clinically Integrated Network (CIN). This hybrid role involves ensuring provider enrollment and compliance, maintaining relationships between payors and providers, and supporting various credentialing functions to meet contractual obligations.
BiotechnologyHealth CareHealth InsuranceMedical
Responsibilities
Ensures providers are enrolled in the Network according to current standards and regulations and maintains stringent compliance with payors
Facilitates preparation for the Network Credentialing Committee, reviewing files for accuracy and completion. Works with the Committee Chair to perform the administrative review process and attain approval sign-off
Responsible for meeting any contractual obligations outlined within all delegated credentialing agreements held by the Network
Serves as the point of contact for Network practices to address claims issues with Network payors by troubleshooting on behalf of the practice and working with the payor to resolve
Provides enrollment assistance/support to Network provider members for nondelegated health plans as needed
Supports new practice onboarding by providing support pertaining to credentialing, execution of participation agreements, health plan enrollment, fee schedules, and ensure smooth transition of support to Network practice transformation team
Performs data entry, collection, and analysis to complete tasks supporting provider primary source verifications and enrollment processes
Responsible for completing various audit activities to ensure contractual compliance and satisfying NCQA standards. Audit activities include annual audits which are initiated by delegated payors, regular auditing of primary source verifications (PSV), and conducting annual audits of sub-delegate groups to the Network, such as the Henry Ford Health Central Verification Office
Ensures Network practice compliance and contractual obligations through comprehensive and manual validation of information (i.e., confirmation of practice hours). Performs tasks to support accurate records and roster management including:
Network provider membership profiles within Network’s data management tool
Updates external provider alignment tools used to align physicians to a particular group for purposes of their quality rewards program
Maintains accurate record of specialist referral information, provider panel status by product line, and Network’s criteria for incentive eligibility
Supports Network patient alignment including but not limited to member transfer submissions and resolution tracking
Responsible for accurate and prompt submission of the Network provider roster to each payor using payor-specific formatting. Additional ad-hoc requests require creation of provider rosters, using variety of data platforms, for multiple use cases
Maintains the Network provider roster for the Accountable Care Organization (ACO) contract including all provider additions, terminations, or changes to the ACO contract
Maintains current payor information, including fee schedules and policies, within the Network's SharePoint website
Through ongoing partnerships and collaboration with non-delegated health plans, ensures all appropriate providers are accurately aligned to Network
Performs outreach to patients due for Medicaid redetermination, provides education to patients on process, answers questions, assists with online forms, and provides enrollment support
Follows the procedures defined by Network’s patient compliant policy including reviewing patient concerns with Network administrative leadership and Network medical directors
Supports the Network communications and education through creating a monthly payor newsletter capturing updates from Network contracted health plans including coding, billing, prior authorizations, upcoming webinars, operations, and provides CPT coding and billing education to Network members
Performs ongoing evaluation, maintenance, and execution of the Network participation agreements. Maintains all policies and procedures related to Network provider affairs and delegated credentialing
Additional responsibilities including, but not limited to:
Maintenance of the Network Behavioral Health Provider Directory
Attending the Network Credentialing Committee as requested by leadership
Submission of Blue Care Network's Medical Care Group affiliation form for Network independent providers
Payor outreach as needed on behalf of providers
Qualification
Required
High school diploma. Associate degree preferred
Two (2) years of provider enrollment, provider billing, or credentialing experience
Demonstrated knowledge of all aspects of the insurance provider enrollment process
Ability to work independently, in a demanding environment, managing deadlines and competing priorities without compromising quality or accuracy
Meticulous, highly organized with strong business acumen, quantitative and analytical skills
Excellent verbal and written communication skills
Comfortable and competent interpreting information and making decisions
Demonstrated ability to interact professionally with all levels of business and clinical organizations
Proficient in Microsoft suite of tools including Outlook, Word, and Excel
Preferred
Associate degree preferred
Proficiency in relevant applications including EPIC, Morrisey, and/or MDStaff preferred
Certified Professional Coder (CPC) preferred
Company
Henry Ford Health
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10001+ employees
H1B Sponsorship
Henry Ford Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (212)
2024 (156)
2023 (134)
2022 (159)
2021 (140)
2020 (153)
Funding
Current Stage
Late StageTotal Funding
$40.27MKey Investors
Mort Harris
2020-06-04Grant· $0.27M
2018-04-09Grant· $20M
2016-12-05Grant· $20M
Leadership Team
Robert Riney
President and CEO
Brenda Craig
Vice President, Integrated Communications
Recent News
2025-11-07
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