Provider Enrollment Specialist

Provider Enrollment Specialist

Department: Revenue Cycle Management

Employment Type: Full Time

Location: Ohio Revenue Cycle Management

Reporting To: Jamie Patterson

Description

A provider enrollment specialist works to ensure that providers are enrolled and re-enrolled with commercial and government payers in a timely and compliant manner.

Schedule:

Monday-Friday

8:00am-4:30pm

Must be able to work in the Brecksville office

Hybrid after training

What you will be doing

• Complete all applications in accordance with government and payor standards and submit applications within the required reporting period.

• Gather and obtain all appropriate documentation for facilities and physicians' payor enrollment.

• Perform necessary follow-up with each Contractor and respond to all inquiries or requests within the allotted timeframe.

• Communicate effectively with the facility Managers, Payors, and Physicians.

• Research facility or physician enrollment and credentialing related issues. Work with the staff to adhere to new policies as well as communicate necessary changes as impacted by regulations (CME's, Licensures, etc.).

• Oversee credentialing process by notifying Credentialing Verification Organization (CVO) and Payors of new and terminated providers and of any changes.

• Complete Payor facility credentialing applications.

• Maintain accurate credentialing files for physicians, physician assistants and all allied health professionals, i.e. licenses, DEA, CV, Malpractice Certificates, Business Licenses, and liability certificates.

• Review and enter physician logs into database.

• Serve as liaison between Credentialing Department and all other facilities to assist with education of and compliance with Medical Staff Bylaws.

• Assist in performing internal compliance investigations and audits throughout the organization, including compiling detailed reports with recommendations to the Compliance Officer and management.

What you know

At least three years credentialing/compliance experience in a healthcare setting.

KNOWLEDGE:

1.Knowledge of credentialing policies and procedures.

2.Knowledge of government application filing.

3.Knowledge of record-keeping practices.

4.Knowledge of customer service principles and techniques.

SKILLS:

1.Skill in using word processing, spreadsheet and database management.

2.Skill in communicating clearly and concisely.

3.Skill in handling confidential information.

4.Ability to analyze, extract and interpret government enrollment and billing regulations.

5.Skill in understanding of practice compliance regulations.

What you will receive

• Competitive wages

• Robust benefit package including medical, dental, life and disability (short- and long-term) insurance

• Generous paid time off (PTO) program

• Seven (7) company paid holidays

• 401(k) retirement plan with company match

• An organization focused on People, Passion, Purpose and Progress

• Inspirational culture