Provider enrollment/application specialist

The Provider Enrollment/Application Specialist is responsible for preparing and submitting the credentialing application and supporting documentation to enroll individual physicians, locations with payers. This position will collaborate closely with Payer Relations, Patient Accounting, and Managed Care representatives.

Job Relationships

Reports to the Sr. Manager Medical Staff Services.

Principal Responsibilities

Provider Enrollment:

• Manage the completion and submission of provider enrollment applications
• Provides continued communication with Operations Stakeholders and Managed Care plans to follow up on applications, provider status changes (effective dates/terminations), demographic changes, etc.
• Understand specific application requirements for each payer including pre-requisites, forms required, supporting documentation (DEA, license, CV, etc..) and regulations
• Maintain documentation and reporting regarding the enrollment process
• Retain records related to completed enrollment applications
• Work closely with provider to expedite completion of forms and requirements, including obtaining signatures, locating required documentation, etc.
• Maintain provider enrollment information within the credentialing database and on-line required credentialing systems.
• Ensure that all credentials files are current and complete according to the expiration date of medical license, board certification, professional liability insurance, DEA, and other pertinent information as required by Client and Client's third-party entities (facilities, payers, etc.)
• Process applications for providers for re-credentialing with facilities and payers
• Collaborate with Patient Accounting and Payer Relations to ensure proper compliance with payers' credentialing requirements.
• Identifies recurring credentialing issues to discuss during regular payer relations meetings, provides appropriate follow-up and documentation as necessary.
• Maintains a positive and professional relationship with all providers, field questions, and collects data, interacts consistently with various departments.

Application Administrator:

• Maintain managed care module in MD Staff.
• Develop and maintain MCO dashboards, database queries/reports.
• Provide user support to Payer Relations for MD Staff.
• Comply with the Springfield Clinic incident reporting policy and procedures.
• Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
• Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
• Perform other job duties as assigned.

Education/Experience

• Bachelor’s degrees in business or related field required or three - five (3-5) years of related experience required.

Knowledge, Skills and Abilities

• Knowledge of commercial credentialing policies and applicable government regulations and standards, and the ability to actively apply that knowledge in the performance of all job duties.
• Familiarity with private and commercial insurance carriers, including Medicare and Medicaid.
• Proficient in all Microsoft Office tools, including Excel, Access, PowerPoint, and Word.
• Ability to manage multiple tasks and work in a fast-paced environment.
• Detail-oriented and able to deliver a high level of accuracy.
• Strong communication skills.
• Ability to recognize a problem and effectively problem-solve, accessing guidance from other resources when necessary.

Working Environment

Requires sitting for long periods of time. Office environment.

PHI/Privacy Level

HIPAA4