Healthcare Enrollment Specialist

7 days ago

North Platte, Nebraska, United States Great Plains Health Full time
Job Summary

We are seeking a highly organized and detail-oriented Payer Enrollment Coordinator to join our team at Great Plains Health. The successful candidate will be responsible for coordinating the payer credentialing enrollment process for all CIN providers, maintaining payer credentialing files, and ensuring all data/documents are kept confidential.

Key Responsibilities
  • Coordinate the payer credentialing enrollment process for all CIN providers
  • Maintain payer credentialing files and ensure all data/documents are kept confidential
  • Coordinate with clinic managers, providers, and the Medical Staff office to gather provider information and signatures for enrollment forms
  • Verify medical and/or professional education, fellowships, relevant board certifications, health care affiliations, work history, licensure, and certifications for the purpose of submitting applications and re-applications to payors and Nebraska Health Partners
  • Maintain payor credentialing databases and rosters, ensuring accuracy and completeness
  • Maintain familiarity with the policies of Nebraska Health Partners, CMS, and Medicaid relating to the payor credentialing process
  • Serve as liaison between Nebraska Health Partners and CIN clinics to ensure providers have continuous membership with the various payors
  • Manage and maintain the CAQH database for all employed GPH providers
  • Work with Revenue Cycle/Clinical staff to complete investigations and/or answer inquiries relating to providers reported out of network
Requirements
  • High School degree or equivalent required
  • Associate degree in administrative or medical office studies preferred
Physical Demands
  • Stands and/or walks two hours per day
  • Sits six hours per day
  • Bends, reaches, and stoops daily
  • Visual acuity, ability to speak and hear, manual dexterity, and eye-hand-foot coordination required
  • Ability to drive an automobile required

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