Provider Enrollment Specialist Job at Western Missouri Medical Center
Provider Enrollment Specialist
REPORTS TO: Revenue Cycle Insights Manager
DEPARTMENT: Fiscal Services
JOB SUMMARY
The Provider Enrollment Specialist is responsible for accurate and prompt enrollment for health plans. Acts as a troubleshooter in resolving payer departmental issues related to enrollment and enrollment follow-up. Communicate effectively with internal teams and develop relationships with health plans, and external customers. The ideal candidate would be an analytical thinker, strong communicator, organized, and possess a positive attitude.
ESSENTIAL FUNCTIONS:
- Ensure protocols are being followed to ensure timely resolution and completion of payer enrollment to ensure no loss of revenue due to untimely payer enrollment
- Follows guidelines in alignment with all health plan requirements as related to the provider credentialing
- Works with both internal and external stakeholders to resolve complex provider enrollment issues, including resolving claim denials related to provider enrollment
- Completes CAQH for all providers and maintains by attesting the accuracy of provider’s information every 120 days in accordance with CAQH
- Promptly submits practice and provider changes to the appropriate parties upon receipt
- Maintain provider’s enrollment status by coordinating revalidations for payers every 2-3 years as required by managed care companies, Medicaid, and Medicare
- Supports special projects requiring knowledge of delegated and non-delegated health plan requirements
- Interacts with varied levels of management, physician office staff and physicians effectively to accomplish credentialing and various elements of implementation and launch
- Maintain up-to-date data for each provider in databases and online systems
- Maintains confidentiality of provider information
- Assist in managing the flow of information between the payers
- Coordinate and prepare reports
- Perform other essential duties as assigned
EDUCATION/EXPERIENCE/SKILLS REQUIRED:
- High school diploma required
- 1 year experience with provider enrollment preferred
FULL-TIME/PART-TIME
Full-Time
SHIFT
Days- Flexible schedule
EXEMPT/NON-EXEMPT
Non-Exempt
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