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Payor Enrollment Senior Specialist

4 months ago

Raleigh, United States FastMed Urgent Care Full time
Job DescriptionJob DescriptionPOSITION SUMMARY:

Responsible for all aspects of the credentialing, re-credentialing and privileging processes for all government and commercial payors who are contracted with FastMed Urgent Care and Family Medicine in accordance with applicable regulatory agencies, state specific requirements, company policies and management service agreements. Cross-training for all payors as well as Credentialing tasks will occur throughout the duration of the specialist’s employment.

DUTIES AND RESPONSIBILITIES:

  • Lead enrollment of new providers and groups with government and commercial payors; and revalidates providers and groups with government and contracted payors
  • Obtain, complete accurately, and timely submit enrollment applications and related documents
  • Complete regular follow up with the payors to ensure applications are being processed in a timely manner
  • Record and track all enrollment activity & outreach to provide documentation and support for payer enrollment for effective dates
  • Creates and maintains CAQH profile and ensures contracted payors receive updated information; and facilitates provider re-attestations of CAQH data as required by CAQH
  • Work with revenue cycle team, credentialing team, and managed care contracting to work through Credentialing & Enrollment claim holds, denials and appeal processes
  • Maintains provider payor information in online credentialing database and appropriate IT database to ensure regular and consistent communication on provider status
  • Ensures practice and provider information is current with health plans, agencies, and other entities (send monthly rosters to payors)
  • Audits payor directories for current and accurate provider information
  • Facilitate payor calls to address contracting and credentialing issues
  • Maintains confidentiality of all information; adheres to all HIPAA guidelines/regulations
  • Utilize all methods available to verify status of enrollment, enrollment instructions and processes, and enrollment applications via outbound calls, web portal access, email communication
  • Follow up with payors to ensure timely application processing/provider enrollment
  • Assist Credentialing and Human Resources departments as needed in effectively onboarding and setting up Providers for successful enrollment
  • Excellent attention to detail and communication skills (verbal and written)

ESSENTIAL EDUCATION AND EXPERIENCE:High School diploma or equivalent; Associate degree preferred; Two (2) or more years of relevant payor enrollment experience required (either government or commercial).Knowledge of MODIO credentialing software preferred. Certified Provider Credentialing Specialist (CPCS) and/or Provider Enrollment Specialist Certificate (PESC) preferred.PHYSICAL DEMANDS:While working the essential functions of this job, the employee is occasionally required to stand, walk, sit, carry, use hands to handle or feel objects, tools or controls, reach with hands and arms, climb stairs, balance, stoop, kneel, crouch or crawl, talk, hear and lift and/or move up to 40 pounds.WORK ENVIRONMENT:While performing the essential functions of the job the employee comes in contact with a wide variety of circumstances. The employee may be exposed to unpleasant situations including accidents, injuries, illnesses, and varying or unpredictable situations.REPORTING TO THIS POSITION:CFOGENERAL SIGN OFF:The team member is expected to adhere to all company policies and act as a role model in so doing as well as provide outstanding customer service. The information contained in this job description is not intended to be exhaustive. FastMed reserves the right to revise and amend job descriptions at any time.