Medical Staff Provider Enrollment Specialist

Concord Hospital, Inc • Laconia, NH

56d

About The Position

Serves as the Hospital's provider enrollment coordinator for all institutional (physician groups and facilities) and professional (practitioner) enrollment activities. Manages and oversees all aspects of provider enrollment and re-enrollment with federal, managed care and other 3rd party payors. May assist in all aspects of credentialing, including appointment, reappointment, privileging and temporary privileges for Medical Staff members and Health Professional Affiliates in medical staff departments. Keeps abreast of current requirements and any changes from regulatory agencies (e.g. CMS Conditions of Participation, NCQA, State laws, and federal regulations) that impact the credentialing and provider enrollment processes and applies this knowledge to credentialing and provider enrollment practices. Ensures compliance with the Concord Hospital Medical Staff Bylaws and Rules and Regulations. Assists with accreditation survey preparation for the Medical Staff Services department and the Medical Staff.

Requirements

• Associates degree with related experience required or a combination of education and Provider enrollment or billing experience will be considered.
• To perform this job successfully, an individual should have knowledge of Microsoft Office, Word, Excel and Access, as well as Credentialing systems.
• Provider enrollment experience strongly preferred.

Nice To Haves

• Bachelor's degree preferred.
• Certified Provider Credentialing Specialist (CPCS) is preferred.

Responsibilities

• Processes necessary documents to ensure that all appropriate practitioners and institutional groups & facilities are enrolled in government programs and are participating in company approved managed care organizations.
• Responds to and resolves problems with provider network participation as it relates to denial of services or reimbursement.
• Maintains all internal and electronic files with appropriate provider and network participation information including the database for federal payors.
• Develops and maintains positive relationships with both internal and external customers (individual contacts for the government and commercial payors).
• Manages and performs critical analysis of each initial credentialing and privileging application, reapplication and temporary privileges for Medical Staff membership and Health Professional Affiliates (HPA) as outlined in policies.
• Processes requests for credentialing, privileging, reapplication, temporary privileges, leave of absence requests, additional privilege requests, staff category changes and resignation for medical staff membership and Health Professional Affiliates (HPA) as outlined in policies.
• Performs other duties as assigned or directed. e.g. Serves as backup to other co-workers.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Hospitals
• Education Level: Associate degree
• Number of Employees: 251-500 employees