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Form of workPosition Summary:
Responsible for the day-to-day payer enrollment service tasks to include payer enrolment, revalidations, and other miscellaneous tasks as required by payers. Serves as the initial point of contact for employed and contracted providers, 3rd party payers, and other enrollment vendors. Assist with policy and procedure review and development, where needed.
ESSENTIAL FUNCTIONS
Work with employed and contracted providers to meet all their payer enrollment credentialing needs outlined in their contract. Maintaining strict confidentiality for matters pertaining to provider enrollment.
Knowledge of provider credentialing/accreditation/insurance regulations, policies, guidelines, and standards.
Completes the processes to enroll and credential providers; i.e., physicians, advanced allied practitioners, etc. with all 3rd party payers adhering to payer requirements and deadlines.
Completes and processes to recredential existing providers.
Gather and maintain current data and documents for all providers in an organized and complete fashion.
Clearly and effectively communicates with providers, physician practice leaders and insurance companies handling questions and resolving issues.
Review and update, if necessary, health plan directories, websites, agencies, and other appropriate entities for current and accurate provider information.
Maintains scheduling grid so dissemination of information to clinics is timely and accurate.
Monitors when credentials are expiring, making sure all providers meet accreditation and regulatory standards.
Assists with development, planning and implementation of processes.
Prepares statistical reports and performs clerical functions such as preparing and sending outgoing mail, distributing incoming mail, maintaining file systems, entering data, and maintaining databases, typing documents and correspondence.
All other job duties as assigned.
Minimum Education:
High School Diploma or GED Required.
Required Qualifications:
Two (2) years' experience in credentialing, privileging, or other medical experience relevant to insurance carrier credentialing, re-credentialing and follow-up preferred.
