Enrollment Specialist

2 weeks ago

Charlotte, United States N2S Healthcare Staffing Solutions LLC Full time

Title: Provider Services Specialist

Duration: 13 weeks

Location: Charlotte, NC 28208

Shift: M-F 8 Am – 5 Pm/ 40 Hrs/ Week

Duties:

  • The Provider Services Specialist is responsible for the timely, accurate, and compliant enrollment of Atrium Health.
  • providers with government payers, as well as the timely and accurate processing, follow-up, and verification of completion of applications for participation in Medicare (NC/SC), NC Medicaid (NC Tracks), SC Medicaid programs for AH providers, and physician groups.
  • The position is responsible for ensuring that the credentialing and enrollment functions are completed in compliance with all Atrium Health, CMS, State, and national accrediting agency(s) standards.

Essential functions:

  • Independently processes and submits complete, timely, and accurate enrollment applications to The Center for Medicare Services (CMS) and state Medicaid offices on behalf of new groups and currently employed Atrium Health Medical Group (AHMG) providers and groups billing under AH MG tax ID numbers.
  • Resolves issues and supports Practice Leadership / Practice Manager regarding provider enrollment and credentialing for AHMG, Affiliates, and the Professional Billing Office.
  • Regularly follows up on the status of submitted applications and provider maintenance requests with CMS and state Medicaid offices and communicates status updates to all constituents via MOAD or other tracking system and email.
  • Demonstrates the ability to communicate professionally and clearly in both verbal and written form to physicians, corporate staff, external agencies, and government / managed care.
  • organizations.
  • Accurately document process steps, dates, and work status in the MOAD system.
  • Answers departmental telephone and emails, routes to appropriate staff, and takes accurate messages as needed. Commits to return all phone and email inquiries within 24 hours even if not resolved.
  • Manages time, prioritizes assignments, and coordinates functions effectively to meet departmental goals and quality standards.
  • Maintains confidentiality of all information related to credentialing and recredentialing.
  • Promotes and assists in the smooth, efficient delivery of departmental services to providers, AH MG, AH, and other corporate departments and outside agencies.
  • Performs other duties and responsibilities as assigned with minimal supervision and within the timeframe specified.
  • Participates in performance improvement activities.
  • Collaborates effectively with all personnel within the department and throughout Atrium.
  • Health.

Education:

  • High School diploma required.
  • College bachelor’s degree preferred.

Certification & Experience:

  • 3+ years’ experience in a role that performs or supports provider enrollment or similar operations in a hospital or managed care environment is required.
  • Certification through the National Association of Medical Staff Services (NAMSS) as a Certified Provider Credential Specialist (CPCS) or Professional Medical Services Management (CPMSM) is preferred.
  • Experience with primary source verifications, Medicare, North & South Carolina Medicaid, NCQA and DOI standards is preferred.

Certification:

  • Staff Services (NAMSS) as Certified Provider Credential Specialist (CPCS)
  • Professional Medical Services Management (CPMSM)
  • Professional Medical managed care environment is required.

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