Provider Enrollment Specialist
2 weeks ago
NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city's five boroughs. Our large health system consists of ambulatory centers, acute care centers, post-acute care/long-term care, rehabilitation programs, Home Care, and Correctional Health Services. Our diverse workforce is uniquely focused on empowering New Yorkers, without exception, to live the healthiest life possible.
At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.
Job Description
Summary of Duties and Responsibilities:
Working under the direct supervision of the Director of Managed Care, Central Office, the Assistant Coordinating Manager/Provider Enrollment will be responsible for the managed care provider enrollment across two to four Health + Hospitals acute care facilities. Key responsibilities include:
- Collect managed care data from assigned hospitals on Medical Staff Office credentialed providers to timely input provider data accurately and maintain a complete provider record in MD-Staff.
- Submit provider data on delegated rosters to contracted managed care plans at least once a month. Record and maintain inventory of milestones dates of provider rosters submitted to managed care plans in MD-Staff.
- Monitor delegated provider rosters submitted to managed care plans and record provider ids and effective dates upon receipt.
- Meet regularly with local hospital administrators to identify non-credentialed providers that require an MD-App and send and process the provider's MD-App in MD-Staff.
- Maintain complete provider records for non-credentialed providers in order to submit to plan for direct credentialing.
- Participate in internal monthly provider enrollment meetings to develop and implement best practices.
- Trouble shoot and identify root cause of provider data problems and collaborate with other departments and stakeholders to resolve issue(s).
- Collaborate with colleagues to respond to managed care plan requests for facility initial and re-credentialing applications for assigned hospitals.
- Assist department with system-wide performance score cards to monitor completeness of provider enrollment with managed care plans.
- Serve as key liaison to Central Office, Centralized Credentialing team, Local Medical Staff Offices, Managed Care plans and other key stakeholders to assist with provider data requests.
- Collaborate with colleagues to ensure providers at assigned hospitals complete Medicaid and Medicare applications.
- Other duties as may be required.
1. A Baccalaureate Degree from an accredited college or university in Business Administration, Community Health, Psychology or related discipline with one year of full-time experience in a supervisory or administrative capacity in business management systems, general administration, health care and medical/patient systems administration; or,
2. A satisfactory combination of education, training and experience.
Department Preferences
- Advanced knowledge of Microsoft Excel (e.g. v-lookup, pivot tables, etc.)
- Knowledge of CAQH
- Analytical thinking
- Excellent communication skills
- Data maintenance and provider enrollment processes with managed care plans.
NYC Health and Hospitals offers a competitive benefits package that includes:
- Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
- Retirement Savings and Pension Plans
- Loan Forgiveness Programs for eligible employees
- Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
- College tuition discounts and professional development opportunities
- Multiple employee discounts programs
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