US Heart and Vascular is in need of a Remote Provider Enrollment & Credentialing Specialist to join our team
Position Summary
Be the first point of contact to staff; resolve enrollment & credentialing issues by answering questions, making recommendations for resolution and escalation, checking enrollment status, verifying payer enrollment requirements and system implementation, appropriately follow-up on Provider Issue Forms; facilitates group and individual enrollment with commercial and government payers.
Responsibilities:
- Resolves issues and concerns by correctly answering questions from staff and providing appropriate follow-up on issues, escalating to Team Manager, when appropriate
- Provides the team with coaching, training, and auditing on assigned tasks. Partner with Team Manager to evaluate team’s performance to improve overall production and facilitate continuous improvement.
- Assists Team Manager in monitoring inventory and production and facilitates the escalation process as needed.
- Become proficient in discussions with payors to facilitate closure of any identified issues.
- Research and review individual Provider Issue Forms for appropriate follow-up and resolution.
- Maintain Matrices - payer enrollment, matrix, SOPs, new site sheets, email templates, welcome letters, etc.
- Create and distribute reports containing provider credentialing and enrollment data for various departments within the organization.
- Research new state enrollment requirements for group and individual provider enrollment.
- Assists Contract Implementation staff with accurately documenting enrollment and billing requirements for payer contracts.
- Maintain and complete new entries in Veritystream.
- Facilitate completion and submission of payer enrollment applications for government and commercial payers.
- Monitor application status process to identify emerging issues and communicate them to Team Manager.
- Monitor enrollment status for groups and individuals.
- Monitor license and credential expiration dates and advise staff members of required “renew” by dates.
- Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases.
- Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.
- Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance
- Complete revalidation requests issued by government payers.
- Credential new providers and re-credential current providers with hospitals at which they hold staff privileges.
- Work closely with the Director of Revenue Cycle and billing staff to identify and resolve any denials or authorization issues related to enrollment & credentialing.
- Performs and assists with other department duties as required.
Knowledge, Skills and Abilities Required:
- Meticulous follow-through of delegated tasks, including follow-up with staff to ensure completion, quality, and meeting deadlines.
- Ability to exhibit leadership by demonstrating commitment to team development, adapting to change in a positive manner, and supporting alignment with organizational goals including continuous improvement efforts.
- Ability to pay close attention to detail and produce extremely accurate work.
- Strong analytical and problem-solving skills.
- Ability to organize and prioritize job tasks and requirements.
- Excellent organizational skills with the ability to prioritize assigned duties in an efficient amount of time.
- Ability to effectively perform in a multi-task work environment.
- Strong communication and interpersonal skills.
- Ability to effectively use oral and written communication skills with clinicians, external agencies and management in a courteous and professional manner.
- Must have knowledge of correct English, proper grammar and spelling.
- Knowledge and skills in using personal computers (Windows) with a strong emphasis on Microsoft Office Programs- Outlook, Word, Excel and Adobe Acrobat
Education & Experience:
- High school diploma or equivalent
- Two (2) years office experience or college course work preferred.
- Knowledge of health plan billing and enrollment preferred.
- PECOS and CAQH experience preferred.
- Veritystream experience a plus.