Provider Enrollment Specialist - CAP
About The Position
The Provider Enrollment Specialist is primarily responsible for the initial and ongoing maintenance of provider and organization data entry and enrollment needed to support multiple functions within the Cayuga Health Partners Network and Centralus Health. This position will be responsible for completing provider enrollment applications according to internal policies, health plan policies, and other regulatory agencies such as NCQA, CMS, and NYS Department of Health, ensuring continued Network compliance. This position acts as a liaison between our Network, CHP providers and practices, and health plans. The Provider Enrollment Specialist will build and maintain professional relationships with Practice billing and credentialing staff, payer-provider representatives, and providers.
Requirements
- Associate's degree
- Two to five (2-5) years of experience, including previous provider enrollment or credentialing experience with IPA / Medical Group / Hospital experience or healthcare operations experience (i.e. claims processing, billing, provider relations or contracting)
Nice To Haves
- Notary Public certification preferred
Responsibilities
- Perform provider enrollment activities as necessary.
- Manage the completion and submission of provider enrollment applications for CHP providers according to plan specifications.
- Understand specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.) and regulations.
- Review and assess for completeness of information of enrollment documents, including current state licensure, liability insurance, DEA, etc.
- Responsible for follow-up with physicians and providers on missing information needed to complete payer enrollment.
- Responsible for the generating, mailing, tracking, and subsequent processing of provider revalidation applications.
- Interacts with representatives from health plans in an effort to resolve any delays in approvals as well as CHP Participants to answer inquiries and clarify requirements.
- Update Provider Data Management System when new information is received.
- Responsible for working with health plans on a routine basis to maintain their Provider Rosters.
- Responsible for notification to health plan and applicable CHP participants. Notification includes date of contract termination, anticipated health plan termination (if different than contract termination) and provider for membership re-assignment.
- Maintain a current and accurate Provider Roster, communicating provider changes to appropriate CHP staff to support Network Initiatives.
- Maintains extensive working knowledge of provider enrollment.
- Is flexible in assuming other appropriate responsibilities not noted above.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
