Payer Enrollment Specialist

Description

POSITION SUMMARY:

Maintains accurate records of providers credentials. Processes providers applications for privileges and reappointments and monitors licensure renewal activity for Physicians and CRNAs.

Essential Duties and Responsibilities:

• Processes initial applications and reappointments for hospitals and surgical centers, for assigned providers.
• Maintains complete file of providers licensure and credentials. Monitors renewals of licensure and forwards copies of licensure to facilities as renewals are received.
• Maintains and updates credentialing database, inclusive of demographic and licensure information.
• Maintains and updates continuing medical education/ACLS credits and other training requirements.
• Request COI for all new hires.
• Maintains and updates curriculum vitae/profiles for each provider.
• Maintains correspondence files and credentialing archival files.
• Performs other credentialing duties as requested.
• Adhere to all company policies and procedures.
• Adherence to and compliance with information systems security is everyone's responsibility. It is the responsibility of every computer user to: Know and follow Information Systems security policies and procedures. Attend Information Systems security training, when offered. Report information systems security problems.
• Maintains strictest confidentiality.
• Maintains and updates annual PPD/TB/CXR/FLU immunization records and forward to facilities.
• Maintains and updates HepB, TDaP, MMR, and Varicella immunizations and forward copies to facilities.
• Maintains and updates COVID immunization records and forward to the facilities as required.
• Front load all new hires and onboarding groups.
• Maintain current notes in Verity on all active applications for each provider.
• Maintain a follow up spreadsheet on all active applications.
• Maintain notes on OPS report for various states.
• Familiar with online applications (Silver sheet, HCA, MDApp, Banner Health Systems and Verity HUB).
• Maintain license/DEA online renewals for specific states.
• Contact individual provider via telephone, Zoom, TEAMS, email or text.
• Perform other duties as assigned.
  
  

Qualifications

Education/Licensing/Certification:

• High School graduate, AS or B.S. degree in business administration or health care related field preferred.
• CPMSC/CPCS Certification preferred
  
  

Experience:

• One(1) year minimum experience in Credentialing.
  
  

Knowledge and Skills:

• Knowledge of organization policies, procedures, and systems
• Skilled in computer applications including MS Word, MS Excel, database administration and scanning applications.
• Skilled in verbal and written communications.
• Familiar with online applications (Silver sheet, HCA, MDApp, Banner Health Systems and Verity HUB).
• Knowledge of state license requirements.
• Knowledgeable in Federal and State Regulation on Confidentiality; and Peer Review Guidelines.
• Ability to work effectively with staff, physicians, and external customers.
• Ability to work independently with limited supervision.
• Must be comfortable with contacting individual provider via telephone, Zoom, TEAMS, email or text.
  
  

Please Note: The position pay range analysis is for the company to take into consideration and is intended to be an aid to help make competitive offers while ensuring internal equity.  It is not meant to be a directive and doesn’t consider all the factors that could be considered when making an offer decision.