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If this describes you then let’s talk!
HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.
Payor Enrollment Coordinator
The Payor Enrollment Coordinator will be primarily responsible for coordinating physician and non-physician enrollment into the Managed Care Plans. This position will work independently and as a valued team member supporting the coordination of all operational aspects of the enrollment/credentialing program, including organizing, compiling key informational data and executing processes and procedures related to internal and external credentialing/appointment, re-credentialing and profile maintenance. Assignments are planned and executed with considerable independence in conformance with established policies, regulations, and laws.
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the abundant opportunities for growth and success.
If this describes you then let’s talk!
HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment.
Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise.
Payor Enrollment Coordinator
Managed Care
The Payor Enrollment Coordinator will be primarily responsible for coordinating physician and non-physician enrollment into the Managed Care Plans. This position will work independently and as a valued team member supporting the coordination of all operational aspects of the enrollment/credentialing program, including organizing, compiling key informational data and executing processes and procedures related to internal and external credentialing/appointment, re-credentialing and profile maintenance. Assignments are planned and executed with considerable independence in conformance with established policies, regulations, and laws.
Duties and Responsibilities
The duties include, but are not limited to:
- Initiates and coordinates the acquisition and receipt of enrollment/credentialing documentation from new and existing providers; provides follow-up and problem resolution as required.
- Coordinates the processing, distribution, and management of all credentialing and accreditation documents for affected providers.
- Collaborates with internal departments (Patient Access, Medical Staff, Physician Practice Management etc.) to ensure smooth on-boarding of providers into HSS PHO
- Assist in the maintenance of accuracy and completeness of internal credentialing database (Cactus).
- Review payer plan applications returned to department for accuracy and completeness, troubleshooting as needed.
- Plan, implement and maintain delegated credentialing processes/status with insurance companies.
- Assist in ensuring that provider participation in the payer plans and CAQH is current, accurate and up to date.
- Assist with for inputting credentialing information into the departmental credentialing system, as necessary to support the Credentialing process.
- Must actively process forms, requesting payer applications, maintaining file system, following up on issues and troubleshooting problems.
- Maintains and ensures strict confidentiality of files and databases.
- Other duties as assigned.
Qualifications or Education, Training and Experience
- Associate Degree or 2+ years’ experience in healthcare
- Knowledge of medical provider credentialing, privileging, and accreditation processes required
- Advanced skills in MS office applications such as Outlook, Word, and Excel
- Strong interpersonal skills
- Ability to communicate effectively, both orally and in writing
- Excellent attention to detail
- Knowledge of medical provider credentialing, privileging, and accreditation processes
Knowledge and Skills/Expected Competencies
- Knowledge of accounting, healthcare, and general office procedures, preferred.
- Working knowledge of payer enrollment processes
- Requires ability to understand, interpret, evaluate, and resolve basic customer service issues.
- Knowledge of the state and federal reimbursement and regulatory guidelines to ensure compliance with State regulations regarding patient and insurance billing issues, preferred.
- Understands common terms used daily in carrying out tasks.
