Provider Enrollment Specialist - CAP

CH_050 Cayuga Medical Center at Ithaca•Ithaca, NY

16h•Hybrid

About The Position

The Provider Enrollment Specialist is primarily responsible for the initial and ongoing maintenance of provider and organization data entry and enrollment to support multiple functions within the Cayuga Health Partners Network and Centralus Health. The position completes provider enrollment applications in accordance with internal policies, health plan policies, and requirements of regulatory agencies such as NCQA, CMS, and the New York State Department of Health, helping ensure continued Network compliance. The specialist serves as a liaison among the Network, CHP providers and practices, and health plans, and builds and maintains professional relationships with practice billing and credentialing staff, payer-provider representatives, and providers. This is a hybrid position, with one to two days per week in the Ithaca, NY office preferred as needed. The position may require occasional driving to practice locations. The pay range is $25.00–$33.00 per hour, plus benefits.

Requirements

Associate's degree.
Two to five years of experience, including previous provider enrollment or credentialing experience with an IPA, medical group, or hospital, or healthcare operations experience such as claims processing, billing, provider relations, or contracting.
No licensure required.
Frequently communicate with practices and providers and exchange accurate information.
Remain at a workstation and move around the workspace as needed to complete job tasks, with or without reasonable accommodation.

Nice To Haves

Notary Public certification.

Responsibilities

Perform provider enrollment activities as needed.
Manage completion and submission of provider enrollment applications for CHP providers according to plan specifications.
Understand payer-specific application requirements, including prerequisites, required forms, completion requirements, supporting documentation, and regulations.
Review enrollment documents for completeness, including current state licensure, liability insurance, and DEA information.
Follow up with physicians and providers to obtain missing information needed to complete payer enrollment.
Generate, mail, track, and process provider revalidation applications.
Work with health plan representatives to resolve approval delays and with CHP Participants to answer inquiries and clarify requirements.
Update the Provider Data Management System when new information is received.
Work routinely with health plans to maintain Provider Rosters.
Notify health plans and applicable CHP participants of contract termination dates, anticipated health plan termination dates when different, and providers for membership reassignment.
Maintain an accurate, current Provider Roster and communicate provider changes to appropriate CHP staff to support Network initiatives.
Assume other appropriate responsibilities as needed.