Provider Enrollment Specialist-Day(FT)

Adena Health•Chillicothe, OH

6d•Hybrid

About The Position

At Adena Health, professional roles shape the systems, strategy, and operational excellence that support patient care across Southern Ohio. These positions are a great fit for leaders and specialists who value purpose-driven work and community impact. The mission statement is “Called to serve our communities” with the guiding principle “Let all that you do be done in love”. The vision is to be the region's most trusted partner in healthcare, with values of Compassion, Excellence, Integrity, and Trust. This role performs administrative and technical duties in the enrollment and re-enrollment activities for all Adena Medical Group providers and Adena Health System facilities, provider clients contracted in the Management Services Organization or Physician Hospital Organization. Enrollment activities may be through a direct relationship or through a delegated agreement with contracted managed care payors, provider networks, government payors, or other contracted entities for the reimbursement of medical services. This position has significant access to confidential employee, patient, organizational and financial information. This position has continuous contact with internal and external customers including physicians and other healthcare providers, administrators, support staff and network representatives. The individual must work independently and work in an organized fashion to coordinate all provider enrollment and credentialing and give direction to others assigned to assist in those activities. Additionally, this position is responsible for communicating provider participation information to stated internal and external customers. Following an orientation period, with appropriate knowledge in payor enrollment functions; employees, at the discretion of their supervisor, may have an opportunity for a schedule to include a remote/work from home. If approved to work from home, individual must hold a dedicated workspace free from distractions with reliable internet access and a strong understanding of company policies.

Requirements

High School Diploma or GED
1-2 years administrative healthcare experience
De-escalation training within 6 months.
Payer enrollment application experience to include, but not limited to, PECOS, CAQH, CMS, BWC functions/requirements.
Excellent written and verbal communication skills
Detail oriented
Functions well with project deadlines
Works collaboratively with individuals at all levels throughout the organization.

Nice To Haves

Associates Degree in Business Administration or related field
3-5 years Physician and/or facility enrollment with a hospital or health plan
Hospital/physician billing experience.
Other related healthcare business experience preferred.

Responsibilities

Accurately complete the enrollment/reenrollment processes as outlined by each network/area for all appropriate healthcare providers and facilities as identified through department policies and network reimbursement and delegated contracts to ensure timely and continued provider network participation.
Maintain detailed provider enrollment files in electronic format, including electronically received documents and scanning of hardcopy documents, and document each stage of enrollment/reenrollment process thoroughly.
Accurately maintain all internal systems with appropriate provider and network participation information.
Maintains good working relationships with Adena Medical Group providers, practice managers, Medical Staff Services and support staff to obtain necessary and timely information to facilitate the provider enrollment/reenrollment process.
Develop and maintain relationships with assigned Payor, Governmental and Network Representatives in order to facilitate the provider enrollment/re-enrollment processes.
Respond to and resolves problems with provider network participation as it relates to denial of covered services or reimbursement by working closely with all levels of administrative and clinical personnel and network representatives.
Work collaboratively with fellow team members to improve department workflows, processes, policies and systems. Additionally, each team member is expected to cross train on location and provider type requirements to assist one another in completing assigned duties as the enrollment cycle warrants.
Actively maintains reports demonstrating provider status and the cycle time to complete each enrollment/re-enrollment activity in the process.
Maintains standardized rosters for submission to payers with delegated credentialing agreements with AHS
Remains compliant and up to date with all payer enrollment industry standards and expectations.