Program Operations Specialist

University of Washington•Seattle, WA

3d•$39 - $44•Remote

About The Position

UW MEDICINE'S CHARGE MASTER REVENUE INTEGRITY DEPARTMENT has an outstanding opportunity for a REVENUE INTEGRITY ENROLLMENT SPECIALIST . SCHEDULE Weekdays 100% Remote DEPARTMENT DESCRIPTION UW Medicine's Revenue Integrity Department is a shared services organization, which supports all of UW Medicine. UW Medicine entities include but are not limited to UW Medical Center (UWMC), Harborview Medical Center (HMC), UW School of Medicine, Northwest Hospital, UW Neighborhood Clinics (UWNC) and UW Physicians. POSITION HIGHLIGHTS Under the general guidance of the Director of Revenue Integrity, the Revenue Integrity Enrollment Specialist is responsible for overseeing and coordinating the provider enrollment process for both new and established providers. This includes gathering and verifying primary source documentation required for initial enrollment and revalidation applications, ensuring completeness and accuracy in accordance with health plan requirements. The role is responsible for submitting and managing enrollment applications with government and commercial payers, monitoring application status and resolving issues to ensure timely approvals. The Revenue Integrity Enrollment Specialist maintains accurate enrollment records and ensures providers are properly enrolled and linked to the appropriate entities, locations and payer networks.

Requirements

Bachelor's Degree
Certification - National Association of Medical Staff Services (NAMSS preferred)
4-6 years experience of administrative experience working within a hospital or healthcare setting
4-6 years experience working directly with hospital personnel such as physicians and allied health practitioners
4-6 years of experience working in one of the following areas: financial clearance, credentialing, billing, denial or case management
Equivalent experience may substitute for degree requirement

Responsibilities

Works with necessary individuals-including physicians, internal customers, other professional staff and their office or clerical staff-to acquire necessary materials and information for provider certification and licensure
Notifies applicants when additional information is requested regarding their background, training, demonstrated ability previous performance, current competence, physical and mental health status, etc.
Performs ongoing provider maintenance for accuracy and completeness
Tracks and manages provider initial enrollment/onboarding and revalidation applications, including primary source verification, preparation of payer and regulatory correspondence, and monitoring responses within UW Medicine’s provider database
Safeguards the integrity of privileged information and credential files in a professional, sensitive manner
Collaborates with physicians, internal stakeholders, and administrative staff to obtain required documentation for provider certification, licensure, and enrollment
Communicates with applicants regarding requests for additional information related to background, training, experience, current competence, and other enrollment
Performs ongoing provider maintenance to ensure accuracy, completeness, and compliance with payer and regulatory standards
Maintains confidentiality and safeguards privileged and sensitive provider information in a professional manner
Gathers and assembles documentation related to denial trends and root causes for Revenue Integrity Denial Taskforce members
Specifically acts as liaison between providers, department managers and payers for claim denial prevention