Payer Enrollment Coordinator

Under the direction and supervision of the Director of Payer Enrollment and Credentialing, the Coordinator is primarily responsible for submitting timely and successful enrollment of new providers with all contracted commercial and governmental payers.The Coordinator must be well organized, accurate, detailed oriented and have strong interpersonal skills. Must be cognizant of the requirements and nuances of each payers' specific application process to avoid unnecessary delays in the provider enrollment process.

Essential Job Duties:

• Complete and submit initial payer enrollment applications for new providers.
• Follow up with payers to ensure application is processing with no items needed until active participating status is achieved.
• Submit recredentialing applications timely.
• Maintain effective dates and Provider ID numbers for each provider/payer.
• Establish and maintain positive and respectful relationships with payers' Provider Relations Representatives.
• Maintain, update and re-attest CAQH profiles for each provider as required.
• Complete Medicare and Medicaid revalidations in a timely manner
• Enter provider data in database and status notes for documentation purposes.
• Work with payer representatives to resolve provider enrollment issues causing gaps in billing or payment denials.
• Establish and maintain excellent working relationships with provider office staff.
• Respond to provider office staff to resolve payer problems such as authorization issues, inaccurate participation status and any other issues that cause barriers to patient care.
• Submit renewal applications to ensure that all providers' state licenses, DEAs and CDS' are renewed timely.
• Complete initial facility appointment applications for new providers for medical staff privileges.
• Facilitate reappointment applications to ensure providers maintain active medical staff privileges.
• Establish and maintain positive relationships with each facility Medical Staff Office representative.

Required Education/Degree:

Preferred 4-year College Degree

Required Work Experience:

3-5 years prior experience in a healthcare, physician practice or credentialing environment

Proficiency in Microsoft Office applications, database and spreadsheet analysis

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