O&P Provider Enrollment Specialist

1 month ago

Tampa, United States Shriners Children's Full time

Company Overview:

Shriners Childrens is a family that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience defines us as leaders in pediatric specialty care for our children and their families.

Job Overview:

Shriners Children's is the premier pediatric burn, orthopaedic, spinal cord injury, cleft lip and palate, and pediatric subspecialties medical center. We have an opportunity for an onsite O&P Provider Enrollment Specialist reporting into our Headquarters location and located at our Central Fabrication Center in Tampa, Florida.

As part of the Shriners Children's Home Office O&P department, the O&P Provider Enrollment Specialist is responsible for coordinating, monitoring and maintaining provider enrollment and re-enrollment for the Pediatric Orthotic & Prosthetic Services (POPS) locations and practitioners / providers participation in all third party and government insurance. The O&P Provider Enrollment Specialist will continuously exemplify the mission, vision, values and customer service philosophy of Shriners Children's in job performance and in service to other persons outside of and throughout the organization.

Responsibilities:

Position Responsibilities:

  • Manages the completion and submission of provider applications for enrollment in all commercial insurance and Medicaid Managed Care plans for multiple locations in the Shriners Children's system. Tracks and maintains enrollments through timely re-validations. Follows strict guidelines to protect providers information, and maintain confidentiality.
  • Works closely with the insurance enrollment departments to discern specific enrollment requirements including pre-requisites, forms, documentation, and timelines. Establishes relationships at the health plans necessary to promote swift enrollment turnaround time. Performs follow-up with insurance payers via phone, email, fax or website to resolve provider enrollment issues. Negotiates to overcome roadblocks. Collaborates with Health Plan Liaisons to address unresponsive health plans or streamline enrollment processes.
  • Maintains accurate records of enrollment activities in OnBase, including but not limited to, maintaining enrollment data, documenting activities through notes, tracking progress on enrollment worksheets, uploading enrollment related documentation and communications, for access by all team members, and to ensure business continuance.
  • Establishes providers CAQH (Council for Affordable Quality Healthcare) profiles. Maintains profiles up to date, uploading documents as required, and re-attesting profiles every 120 days. Maintains MCC (Minnesota Credentialing Collaborative) profiles for providers at our Minnesota location, if applicable.
  • Coordinates with hospital staff to obtain provider signatures and additional data necessary for enrollments. Establishes and maintains positive relationships with staff, both at the hospitals and Headquarters.
  • Prioritizes workload, so as to promote hospital revenue goals, and to support Network Management contracting efforts as needed.
  • Point of contact for hospitals and HQ personnel for questions relating to enrollment with Commercial Insurance and Medicaid Managed Care plans. Addresses inquiries in a timely manner, includes appropriate personnel, and escalates issues as appropriate.
  • Performs other duties as assigned.


Qualifications:

Experience:

  • 1 or more years of provider enrollment or credentialing experience required
  • Expertise with AdobePro and MS Office products (Excel, Word, PowerPoint, Outlook) required
  • Database management skills required, including querying, reporting, and document generation
  • Experience with Medicare, State Medicaid, and third party practitioner enrollment preferred
  • Experience with CAQH, MD-Staff or other credentialing/enrollment databases preferred

Education:

  • High School diploma or GED required
  • Associates Degree preferred

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