Provider Enrollment Specialist

2 weeks ago

Sayre, United States Guthrie Full time
Job Description

Position Summary:

The Provider Enrollment Specialist reporting to the Payor Contracting & Provider Enrollment Manager plays an essential role in ensuring the success and financial stability of The Guthrie Clinic. The team has the direct responsibility for ensuring accurate and timely completion and monitoring of enrollment and re-enrollment process for over 500 Guthrie Medical Group providers and facilities to be compensated for services performed by providers. Of key importance is accurate and timely entry of provider data, resolving issues and barriers with payor credentialing teams. Proactive internal and external communication including but not limited to Guthrie Medical Group, government agencies, payors organizations, providers, and each department managers.

Education, License & Cert:

Associate Degree required; Bachelors preferred. May be satisfied with previous administrative experience or experience in the health care billing industry.

Experience:

Must possess knowledge of provider enrollment requirements for Government agencies, payor organizations and insurance regulations.

Working knowledge of Spread-sheet Design and use of Excel

Experience with general computer software (Word, Excel, Outlook required).

Ability to learn new software programs quickly

Excellent customer service skills

Excellent verbal and written communication skills

Professional and effective interaction skills with co-workers, clients, providers, and vendors.

Proven ability to work well individually and as a team member.

Ability to prioritize and organize multiple tasks.

Strong attention to detail

Ability to adapt to constantly changing environment

Discretion when handling confidential information

Essential Functions:

1. Responsible for accurate and timely enrollment and re-enrollment with payers' partners by completing all activities required from contractual agreements. This would include all pertinent documentation and credentials, maintain all records and enrollment forms and validation that all appropriate parties have completed signature and notary requirements for all Federal and Commercial payors in two states for over 500 practitioners.

2. Develop and facilitate all required enrollment/re-enrollment application data and associated correspondence in a timely manner for each payor partner to confirm and monitor status of each step within the application process. This will include entering and maintaining all provider information into our credentialing database as well as the generation of reports.

3. Maintain provider demographics and credentials in the Council for Affordable Quality Healthcare (CAQH) national credentialing database.

4. Completes monthly and quarterly reports, rosters and/or updates as required for Delegated Credentialing Payers

5. Utilizes ECHO database and EPIC system to accurately perform assigned tasks including maintaining current insurance plan information, checklists for providers, generating system reports, tracking expiring credentials.

6. Collaborate with SER Coordinator to maintain accurate enrollment/billing information within EPIC.

7. Monitor and review EPIC Provider Workquees, providing feedback to CRC-Insurance Department bi-monthly to facilitate release of provider claims.

8. Liaison between CRC Insurance Depart, Reimbursement Department and third-party payers to facilitate payment on outstanding and /or pended claims. 9. Central point of contact for enrollment inquiries from provider offices.

10. Handles special projects and roster requests, sometimes in a short notice for payors or internal departments and other duties as assigned.

Other Duties:

1. Maintain knowledge and performs within the compliance of corporate policies and payer guidelines.

2. Demonstrates excellent ability to communicate and interact with a wide cross-section of individuals in a courteous, intelligent and tactful manner. To include both internal and external departments, payers and customers. Committed to quality customer services which includes both patient and employee satisfaction.

3. Demonstrates excellent problem-solving skills, able to prioritize and can work independently and on a team.

4. Maintains strict confidentiality related to physicians credentialing information and patient health information in accordance with HIPAA compliance.

5. Professional presence and comfort level to facilitate working with health care professionals and payors.

6. Provides feedback related to workflow processes in order to promote efficiency.

About Us

Joining the Guthrie team allows you to become a part of a tradition of excellence in health care. In all areas and at all levels of Guthrie, you'll find staff members who have committed themselves to serving the community.

The Guthrie Clinic is an Equal Opportunity Employer that welcomes and encourages diversity in the workplace.

The Guthrie Clinic is a non-profit, integrated, practicing physician-led organization in the Twin Tiers of New York and Pennsylvania. Our multi-specialty group practice of more than 500 physicians and 302 advanced practice providers offers 47 specialties through a regional office network providing primary and specialty care in 22 communities. Guthrie Medical Education Programs include General Surgery, Internal Medicine, Emergency Medicine, Family Medicine, Anesthesiology and Orthopedic Surgery Residency, as well as Cardiovascular, Gastroenterology and Pulmonary Critical Care Fellowship programs. Guthrie is also a clinical campus for the Geisinger Commonwealth School of Medicine.

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