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Payer Enrollment Coordinator

3 months ago

Rockville, United States National Spine & Pain Full time
Job DescriptionJob DescriptionDescription:

Position Summary:


The Payer Enrollment Coordinator coordinates and facilitates the enrollment of National Spine & Pain Centers professional and surgery center providers and facilities with various payers for service reimbursement. Responsible for obtaining and maintaining payer participation by timely completion of payer applications for submission to government and commercial health plans. Performs continuous follow ups on enrollment application submissions to meet provider start dates and deadlines. Assists in resolving enrollment issues as they relate to claims payment. Maintains credentialing system with accurate notes and provider statuses for collaborative flow of information from department to field. This is not a credentialing specialist position, but having previous experience in that role is a plus.


Duties:


· Handles highly sensitive and confidential information regarding professional providers.

· Completes provider payer enrollment/credentialing and re-credentialing with all identified payers in a timely manner.

· Maintains positive working relationships to foster collaborative open communication with departmental team, physicians, non-physicians, office staff, management, contracting, insurers, and others as identified.

· Resolves enrollment issues as identified on monthly holds report provided by Revenue Cycle department.

· Appropriately submit clean applications to payers along with supporting documentation to aid in timely processing.

· High level performance to meet KPI standards by ensuring that workflows are followed to document submissions, follow ups and participation status.

· Maintain and update provider files, rosters, and enrollment databases, including but not limited to delegation rosters, CAQH profiles, payer databases, NPI database, PECOS, and any others as needed.

· Remain abreast of current health plan and agency requirements for credentialing of providers.

· Provides weekly updates to on-site practice management staff and others with enrollment statuses and any changes to requirements for credentialing individual providers based on government and commercial payer credentialing processes. Proactively communicated any changes regarding contracting/credentialing as it relates to enrollment and operations.

· Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and teamwork with departments, vendors, etc.

· Utilizes credentialing database and spreadsheets for tracking organization providers. Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management.

· Continuously searches for process improvements to achieve accuracy and efficiency.

Requirements:

A successful Candidate will possess the following skills:


· 3+ years of applicable experience in credentialing and enrollment. Multi-specialty and multi-state experience is a big plus.

· Excellent written and verbal communication skills with superior attention to detail.

· Ability to multi-task under tight timelines with strong administrative and exceptional organizational skills.

· Proficient in Microsoft Office Suite; Word, Excel, PowerPoint, and Outlook.

· Advanced knowledge of credentialing software – CredentialStream by VerityStream.

· Advanced knowledge of PECOS, Payer Portals, and CAQH

· Ability to present information effectively in one-on-one and small group situations to patients, providers and other employees in the organization.

· Ability to understand and demonstrate outstanding customer service to all internal and external customers at all times.

· Ability to maintain complete confidentiality of information at all times.

· Knowledge of the business and legal implications of work and words in healthcare.