Julie Lor

Bachelor's

Healthcare Management

aka Fairview Health Services

Senior Delegated Compliance Coordinator

- Maintains delegated credentialing program to ensure all regulatory requirements including system and departmental policies, National Committee for Quality Assurance (NCQA) and Joint Commission (JC) accreditation standards are met - Works with Manager to establish contracts with new payers and updates current payer contracts - Maintains processes and coordinates workload/tasks with Delegated Credentialing Coordinator to ensure all pertinent information is released to third party payers as defined in contracts - Establishes and maintains process with applicable billing offices to confirm enrollment with payers is complete and accurate - Investigates and resolves discrepancies and enrollment issues related to credentialing with the delegated payers to ensure providers are able to submit claims - Coordinates requests, inquiries and data needed by the delegated payers or internal requestors - Participates in credentialing portion of NCQA surveys at third party payer sites - Works with Manager to ensure department's performance improvement program is in compliance with applicable NCQA accreditation standards - Assists Manager with quarterly and annual performance improvement program reports - Assists with analyzing customer satisfaction surveys from practitioners, entities and health plans - Completes comprehensive internal file audits to ensure compliance with accreditation standards - Utilize independent judgment to perform a wide variety of tasks in a professional way to maintain positive relationships between different areas in department and throughout Fairview - Assists Manager with all credentialing audits throughout the system, including, but not limited to JC, CMS, Minnesota Department of Health (MDH), and Det Norske Veritas (DNV - Attends NAMSS and MAMSS conferences/seminars/webinars to obtain continuing education credits to maintain certification and to stay current with industry and community trends