Duration: 3 months to start
Job Description
- This role is responsible for gathering and verifying healthcare practitioner information and tracking all compliance information related to the enrollment and re-credentialing process.
- This includes processing all incoming applications to ensure accuracy at completion and that all required licensing and certification documentation is present, as well as all additional required documentation.
- All necessary file maintenance functions, including updating service locations, rendering provider information; licensure and ownership information is also a function of this position.
- Provides reviews and prepares new hire enrollment packets for accuracy, completeness and timely submission to the payers and maintains current provider information in order to ensure timely reimbursement of payment for services.
- Performs follow-up with the physicians to request necessary documentation for the application/re-credentialing process (Renewal reminders must be sent 30 days prior to the expiration date).
- Maintains a working knowledge of payers’ processes and updates and ensures that the physician database and NPPES system is kept accurate and current. CAQH re-attestation to occur every 120 days for all providers.
- Maintains files, scans credentials and monitors expiration dates and notifies administrators and Enrollment Manager of deadlines.
- Initiates phone calls, generates letters and other correspondence as required for follow up with payers to ensure timely receipt of provider participation effective dates and numbers (goal is within 60 days of payer receipt date of the application).
- Assures that all contacts and discussion with payers are documented and maintained, as well as copies of emails and/or written correspondence sent to third party payers, for future reference.
- Reviews and provides research results to the Billing Department to assist with claims issue resolution.
- At least two (2) years Previous experience with insurance verification, billing and/or provider relations.
- At least two (2) years medical insurance verification/provider relations.
- Working knowledge of insurance billing/provider operations within a large healthcare organization.
- Knowledge of Medicare and Medicaid policies and procedures.
- Basic proficiency with MS Word, Power Point, Excel computer programs.
- Knowledge of the ECHO, NAVINET and CAQH systems.
- Solid critical thinking / problem-solving skills.
- Solid analytical and organizational skills.
- Ability to collaborate with stakeholders at all levels.
- Required Education: High School Diploma/GED
- Preferred Education: Associate's Degree
- Minimum Degree Required: Completed High School (Diploma or GED)
#LI-Hybrid
