Lead Provider Enrollment Specialist
About The Position
This position leads the timely and accurate provider enrollment of employed and contracted providers with payers. The role is responsible for processing initial applications and reappointment applications to credential and privilege the medical staff. Performing primary source verification and ensuring that all physicians, dentists, and allied health professionals are clinically qualified to perform the privileges requested are major responsibilities of this position. Meeting facilitation is also a key duty. Work is performed in compliance with detailed requirements, guidelines, and deadlines of the Joint Commission, Centers for Medicare & Medicaid Services, National Committee for Quality Assurance (NCQA), accrediting organizations and regulatory agencies.
Requirements
- High School or Equivalent (GED)
- 3 months – 1 year of experience
- Must be able to perform duties on typewriters, dictation equipment, office equipment, word processors and personal computers.
Nice To Haves
- One (1) year of previous related work experience in health care preferred.
Responsibilities
- Leads and coordinates payer enrollment, re-enrollment, and re-validation for providers.
- Maintains proactive communication with payers regarding the status of provider enrollment and works closely with providers to obtain necessary documentation to complete enrollment.
- Maintains timelines on enrollment processes and communicates provider participation updates, and resolves enrollment application issues and deficiencies promptly.
- Reviews new Medical Staff applications for completeness and verifies the information.
- Initiates Medical Staff reappointments on a timely basis according to the Bylaws and does a regular follow-up on those that are not returned.
- Queries the Data Bank as necessary.
- Accurately and promptly updates and maintains Medical Staff files, records, reports, confidential materials and applications as directed for easy retrieval.
- Coordinates the necessary arrangements for Medical Staff Meetings (i.e. informing the participants, scheduling, distributing correspondence, etc.).
- Efficiently and politely handles telephone calls, answering questions whenever possible and directing calls to the appropriate individuals.
- Ensures that accurate messages reach parties on a timely basis.
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What This Job Offers
Career Level
Entry Level
Education Level
High school or GED
