Specialist-Payer Enrollment

Overview

Job Summary

Generates enrollment or affiliation applications to submit per established protocols. Reviews for accuracy all enrollment applications and re-credentialing documents prior to submission. Follows established workflows to ensure that proper enrollments are submitted and that timely follow up is performed. This includes prompt response to follow up requests from payers or facilities. Assists in continuous reevaluation of workflows to ensure efficient processes are being followed. Supports the Manager and Director in the efforts to confirm the credentials and primary data source verifications of physicians and mid-level providers joining Baptist Medical Group. Communicates directly with providers, payers, clinic personnel, Operation Directors and Managers and Executive Directors as needed. Generates reports. Performs data entry. Performs primary data source verification. Performs CAQH attestation. Each function requires the highest level of accuracy and confidentiality. Performs other duties as assigned.

Responsibilities

• Maintains current knowledge of credentialing practices and standards.
• Completes government and commercial insurance enrollment applications for new and established providers within BMG and BMG Foundations.
• Providers excellent service to all customers: patients, providers, payers, clinic staff, Physician Revenue Cycle staff, Operations and Administration.
• Maintains current licensure, DEA, certifications, board certifications and all other credentialing documents.
• Reviews EPIC's related to payer enrollment on a daily basis.
• Completes assigned goals.

Specifications

Experience

• #N/A

Minimum Required

• 2 years focused credentialing experience in a medical billing organization.

Preferred/Desired

Education

Minimum Required

• High School/GED

Preferred/Desired

• Medical Billing and Coding Diploma from an accredited facility.

Training

Minimum Required

• Proficient in Microsoft Office. Ability to type 35 wpm

Preferred/Desired

Special Skills

Minimum Required

• Excellent skills in verbal and written communication.

Preferred/Desired

• Working knowledge of CAQH, AMA, NPDB, and primary data source verification. Specific knowledge of payer enrollment application process.

Licensure

Minimum Required

Preferred/Desired