Provider Enrollment Specialist #66253
Job Summary : The Provider Enrollment Specialist is responsible for the timely submission of provider enrollment applications to governmental and commercial payers and for performing the tracking and follow-up required until providers are established and linked to the appropriate EMHS group entity.
Job Functions and Duties
- Manage the successful completion and submission of provider enrollment applications.
- Perform tracking and follow-up to ensure providers are established and linked to the appropriate EMHS group entity in a timely manner.
- Understand specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation and regulations
- Maintain documentation and reporting regarding provider enrollments in process.
- Maintain provider enrollment files electronically via EMHS credentialing software, shared computer files and CAQH (Council for Affordable Quality Healthcare).
- Work closely with departments credentialing staff and member hospitals to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc..
- Ensure that established provider IDs and effective dates are communicated to appropriate billing and revenue departments so claims can be processed for submission.
- Maintain provider enrollment information within the EMHS credentialing database.
- Establish close working relationships within department and with various departments across system.
- Process and distribute appropriate correspondence.
- Maintain working knowledge of applicable regulations, policies and procedures.
- Represent the office to internal and external customers as appropriate.
- Perform miscellaneous job-related duties as assigned.
Note: The duties listed above reflect the majority of the duties of this job and does not, nor is it intended to, reflect all duties that may be required for an incumbent in this job to perform.
Required Education and Experience:
- Associates degree or high school diploma/equivalent with at least 2 years of medical office experience
- General understanding of the medical staff organization and Joint Commission/Healthcare Facilities Accreditation Program/National Committee for Quality Assurance standards. State/federal/licensure regulations, particularly as it relates to the provider enrollment
- Experience with Microsoft Office products, including but not limited to Excel and Outlook
Preferred Education and Experience:
- Bachelor's degree
- NAMSS Certification as a Certified Provider Credentials Specialist (CPCS) or Certified Professional Medical Services Manager (CPMSM)
- NAMSS Certification as either Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS)
- Affiliation and participation with the Maine Association Medical Staff Services
Knowledge, Skills, and Abilities
- Excellent attention to details
- Ability to research and analyze documents.
- Ability to work independently, set priorities and meet deadlines with minimal supervision
- Strong working knowledge of word processing, spreadsheets, data entry, data base experience and other computer related skills. Experience with other Microsoft Office products and HealthLine
- Systems ECHO credentialing software preferred.
- Ability to communicate effectively, both orally and in writing.
- Must be able to communicate well with a wide variety of contacts at all levels of the organization.
- Must be able to work cohesively in a team oriented environment and be able to foster good working relationships with others both within and outside the organization.
- Ability to maintain confidentiality, work with deadlines and manage multiple priorities.
- Ability to maintain a high degree of professionalism and independent judgment in response to complex sensitive issues and decision-making.
- Ability to understand contracting and billing practices relating to EMHS provider enrollment.