Provider Enrollment Specialist - Jackson, United States - St. John's Health

Description

*Remote roles based outside of our primary office in Wyoming can sit in any of the following states: AZ, CO, GA, ID, IL, LA, MI, MO, MT, NV, OK, OR, SC, TN, TX, UT and WA. Please only apply if you are able to live and work primarily in one of the states listed above. State locations and specifics are subject to change as our hiring requirements shift.

Job Summary:
Collaboration with various physicians, leaders, and key parties with payor relationships.

Prepare and submit enrollment applications to payors for the purpose of collecting on reassignment of benefits from employed or contracted practitioners.

Maintain timelines/calendars on enrollment processes; Communicates and collaborates with providers and other departments as needed; clarifies insurance requests for information; keeps a strict level of confidentiality for all matters pertaining to practitioners.

Adheres to and practices the SJH Corporate Compliance Program and participates in performance improvement activities.


Essential Functions:

Initiates contact with practitioners for enrollment purposes; gain delegation authorization to act on behalf of the practitioner in preparing and submitting applications and requirements for payor enrollments.

Information includes but is not limited to provider personal identifiers; all state licenses; DEA registration; education, and board certifications required for CMS/ PECOS/CAQH participation.

Gathers malpractice insurance and claims data dictated by URAC and NCQA.

Follows up on payer and practitioner inquiries; tracks application submission timelines to monitor for effective dates. Collaborates with Revenue Cycle and multiple key parties. Team member on managed care efforts. Ensures back up appropriately in place.

Respond to internal and external inquiries regarding enrollments as pertains to billers concerns and denials; also works with patients on insurance concerns and payment denials.

Works closely with Managed Care items and collaborates with team on payor contracts.

Enrolls and recredentials Teton County Hospital District Entity and dba sites with CMS, Medicaid's, and all commercial insurances under contract.

Updates Medicaid's and commercial insurances as required with all licensure renewals; facility and practitioner; and malpractice and liability insurance renewals.

Enroll facility EFT applications as required.

Consults with Patient Financial Services, Administration, Executive Director of Physician Services, to determine enrollment issues to be addressed. Keep record of Medical Staff services notifications. Maintain MDStaff file in Managed Care Module and shared computer files for non-staff HR practitioners.

Maintains, develops, and updates skills and knowledge to implement ideal service for practitioners, facility, patients, and community.


Job Requirements:

Minimum Education

Preferred: Certified Provider Credentialing Specialist (CPCS) through the National Association Medical Staff Services (NAMSS)


Minimum Work Experience

Required: Effective communication, organization, collaboration, phone, and customer service skills. Must be proficient in Word and Excel

Preferred: Minimum of two years of clerical experience preferred, or certification(s) or degree. Knowledge of some billing criteria as pertains to enrollments and payor contracts.


Functional Demands:

Working Conditions:
Virtual home office, computer use 40 hours week, possible stressful situations related to the interpersonal nature of issues.

Physical Requirements: Sitting/standing 8 hours a day using the computer and phone