Payer Enrollment Specialist
1 day ago
Job Summary
Catholic Health Service is seeking a highly skilled Payer Enrollment Coordinator to join our team. The successful candidate will work closely with our physician partners to ensure timely and accurate physician contracting. This role is responsible for coordinating the transition of physician payer enrollment to the IPA, interacting with Business Development, Provider Relations, insurance companies, and physician offices to effectively enroll providers in CHSPP contracts, and mitigating claims issues as needed.
Key Responsibilities
Serve as liaison between Practice Administrators and/or Billing Managers and insurance carriers
Respond to requests for information and telephone inquiries from Provider and insurance carriers
Assist in the training of new and temporary staff
Work with the insurance carriers to investigate, research, track, resolve, and communicate claims issues related to payment and contractual rates
Submit monthly rosters to payers to add/update the physician network
Update physician practice demographic information and payer plan information in Salesforce
Perform quality control in Salesforce and other applicable databases to ensure it reflects updated provider insurance plan information accurately and timely
Diagnose and solve root causes around missing effective dates or claims issues with commercial payers
Review and verify enrollment grids for accuracy
Monitor CAQH to ensure data elements are accurate
Coordinate the reconciliation process for assigned practices
Report trends of payer behavior
Stay informed on product information, changes in CMS/Commercial Payer procedures, and updates in policies
Manage short-term projects and tasks as assigned by supervisor such as payer data reconciliations
Contribute to other company and departmental needs as requested
Maintain a climate of teamwork and collaborating problem-solving
Requirements
High School diploma or equivalent required
Strong knowledge of medical insurance and healthcare billing
Establishes and demonstrates competency in accounts receivable systems and associated applications
Ability to communicate effectively with insurance carriers, patients, and co-workers
Ability to comply with procedural guidelines and instructions and to solicit assistance when situations arise that deviate from the norm
Excellent verbal and auditory skills are required for communicating with internal staff, customers, and representatives from external departments and agencies
Salary Range USD $25.60 - USD $28.20 /Hr. This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate's qualifications, skills, competencies, and experience
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