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Credentialing and Provider Enrollment Specialist
2 months ago
This position plays a critical role in ensuring the University of Virginia's compliance with delegated credentialing and enrollment processes for healthcare providers. The successful candidate will be responsible for maintaining accurate and up-to-date enrollment information for Medicare, Medicaid, and managed care payors.
Key Responsibilities- Assist in the enrollment of new physicians with government and managed care payors, ensuring timely and accurate completion of applications.
- Work with the Human Resources department to ensure employment agreements are renewed in a timely manner, minimizing delays in professional billing.
- Handle enrollment information for Medicare and Medicaid, ensuring the highest level of accuracy and completeness.
- Complete the enrollment process, including tracking applications and obtaining provider numbers.
- Collaborate with the Insurance Processing Unit to resolve provider issue denials and work with payors on changes, such as address updates and name changes.
- Responsible for creating and maintaining the Professional Billing Spreadsheet, forwarding it to the EPIC PB Team for new physicians and allied health professionals.
- Authorize updates to the provider professional billing record in EPIC and coordinate leased professional providers with UPG Legal, UVAHR, and UVA Clinical Staff Office.
- Collaborate with UPG IPU on provider-related claim denials and act as a liaison between payors and UPG until resolution and claim reprocessing.
- Assist with payor transparency by communicating discrepancies between payor and UPG/UVACHMG enrollment information.
- Reach out to physicians and allied health professionals to obtain access to the CMS PECOS portal for Medicare enrollment and NPI updates via the NPPES portal.
- Update and enter credentialing information into the Symplr provider database shared with the CSO, including practice address information.
- Assist with projects related to new practice locations for UPG and UVACHMG, including relocation and changes.
- Maintain confidentiality of credentialing and enrollment information and provide backup coverage to the enrollment team.
- High school graduate or equivalent required; Bachelor's Degree preferred.
- 5 years of prior experience in a healthcare environment, with experience working accurately under time pressures and anticipating end-users' problems.
- Intermediate knowledge of and experience utilizing a personal computer, intermediate word processing and spreadsheet skills, and basic knowledge of database software or willingness to attain such within 6 months of hire.
