Description:
Provider Enrollment Coordinator
Position Introduction and Overview:
This role will report to our Provider Enrollment Supervisor
Responsible for reviewing and processing credentialing applications and supporting documentation for the purpose of enrolling individual physicians and physician groups in Medicaid and Medicare. Responsible for accurate and timely processing of Part B provider enrollment applications.
Roles & Responsibilities:
Ability to work within a deadline-intense environment.
Interact professionally with providers and staff representatives to provide information on any necessary documentation required for processing.
Plan, prioritize, organize and complete work to meet established objectives.
Track and follow up with providers for timely return of all required documents and applications.
Assists in synchronization of data among multiple systems
Validates the data to be housed on provider databases and ensuring adherence to business and system requirements of customers as it pertains to contracting, network management and credentialing
Display in-depth knowledge of and execute all standard operating procedures (SOPs) as well as communicating issues, trends, concerns and suggestions to leadership.
In-depth working knowledge of the various payer applications associated and the workflow process.
Ensure all workflow items are completed within the set turn-around-time, meeting quality expectations.
Basic Qualifications:
1-3 years of experience in a centralized credentialing office and direct provider enrollment experience, such as credentialing or file maintenance, preferred with experience in Word and Excel
Knowledge of health plan and governmental payer credentialing, enrollment and requirements acquired through completion of a CPCS certification course, or sufficient job-related experience with intent to pursue certification.
Knowledge of PECOS and State Medicaid Enrollment applications
Preferred Qualifications:
Experience with MD Staff credentialing and enrollment software preferred
Knowledge of standards interpretation as related to NCQA