PROCESSING APPLICATION
Hold tight! We’re comparing your resume to the job requirements…
ARE YOU SURE YOU WANT TO APPLY TO THIS JOB?
Based on your Resume, it doesn't look like you meet the requirements from the employer. You can still apply if you think you’re a fit.
Job Requirements of Provider Enrollment Specialist:
-
Employment Type:
Full-Time
-
Location:
Charleston, WV (Onsite)
Do you meet the requirements for this job?
Provider Enrollment Specialist
Allegheny Health Network
**Job Description :**
**GENERAL OVERVIEW:**
Coordinates and facilitates the enrollment of Allegheny Clinic professional providers with various payers for professional services reimbursement
Reviews provider credentialing and/or recredentialing data for accuracy based on licensing requirements and various insurer payer requirements
Obtains information from professional providers and other sources
Completes timely application processes based on payer specific formats
Continually follows up on enrollment and/or recredentialing statuses until complete
Resolves issues as they are identified in a timely manner
Maintains systems/applications used in the enrollment processes.
**ESSENTIAL RESPONSIBILITIES:**
+ Completes provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner
Handles highly sensitive and confidential information regarding professional providers
(50%)
+ Resolves enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others as identified
Maintains positive working relationships with providers
Plays an active role in explaining and informing providers and practice/office managers of the submission requirements for credentialing/recredentialing processes, stressing the importance of compliance with these processes
(15%)
+ Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc
Identifies and resolves problems with primary source verification elements by interpreting, analyzing, and researching data
(10%)
+ Proactively obtains updated provider credentialing data prior to expiration
Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions
Completes all additions, updates, and deletions
Supports new provider onboarding processes as related to enrollment
(5%)
+ Provides updates to on-site practice management staff and others with any changes to requirements for credentialing individual providers based on government and commercial payer credentialing processes
Proactively communicated any changes regarding contracting as it relates to enrollment and operations
(5%)
+ Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and team work with departments, vendors, etc
(5%)
+ Develops databases and spreadsheets for tracking organization providers
Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management
(5%)
+ Continuously searches for process improvements to achieve accuracy and efficiencies
(5%)
+ Performs other duties as assigned or required.
**QUALIFICATIONS:**
Minimum
+ 2 years experience in a physician medical practice with a basic understanding of various payer billing requirements and claims processing or experience with payer credentialing/enrollment requirements
+ Advanced computer skills using word, excel, adobe and web-based applications
+ Excellent customer service, follow-up, and communication skills
Preferred
+ Associate's degree
+ Certified Provider Credentialing Support (CPCS) by the National Association Medical Staff Services
+ Experience with ECHO and/or professional provider credentialing
+ Delegated credentialing experience
+ Experience with Cactus and/or other professional provider credentialing software
**_Disclaimer:_** _The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title
It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job._
**_Compliance Requirement_** _: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies._
_As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times
In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy._
_Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct
This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements._
**Pay Range Minimum:**
$20.15
**Pay Range Maximum:**
$30.93
_Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations
The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets._
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law
Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled/Sexual Orientation/Gender Identity ( _
We endeavor to make this site accessible to any and all users
If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please contact HR Services Online at
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
Req ID: J251092
Recommended Skills
- Adobe
- Billing
- Claim Processing
- Communication
- Confidentiality
- Credentialing
Help us improve CareerBuilder by providing feedback about this job: Report this job
Job ID: NDQ5NzoyNjY2OTIxMjA
CareerBuilder TIP
For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Learn more.
By applying to a job using CareerBuilder you are agreeing to comply with and be subject to the CareerBuilder Terms and Conditions for use of our website. To use our website, you must agree with the Terms and Conditions and both meet and comply with their provisions.