Provider Enrollment Specialist
Provider Enrollment Specialist
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Salary Not Disclosed
1 Vacancy
Job Description
SHIFT:
Day (United States of America)Seeking Breakthrough Makers
Childrens Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20000 Breakthrough Makers will inspire you to pursue passions develop expertise and drive innovation.
At CHOP your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric careand your career.
CHOPs Commitment to Diversity Equity and Inclusion
CHOP is committed to building an inclusive culture where employees feel a sense of belonging connection and community within their workplace. We are a team dedicated to fostering an environment that allows for all to be their authentic selves. We are focused on attracting cultivating and retaining talent who can help us deliver on our mission to be a world leader in the advancement of healthcare for children. We strongly encourage candidates of all races colors ethnicities religions perspectives sexes backgrounds and lived experiences to apply.
A Brief Overview
This role is responsible for gathering and verifying healthcare practitioner information and tracking all compliance information related to the enrollment and recredentialing process. This includes processing all incoming applications to ensure accuracy at completion and that all required licensing and certification documentation is present as well as all additional required documentation. All necessary file maintenance functions including updating service locations rendering provider information; licensure and ownership information is also a function of this position.
What you will do
- Provides reviews and prepares new hire enrollment packets for accuracy completeness and timely submission to the payers and maintains current provider information in order to ensure timely reimbursement of payment for services. Performs followup with the physicians to request necessary documentation for the application/recredentialing process (Renewal reminders must be sent 30 days prior to the expiration date).
- Maintains a working knowledge of payers processes and updates and ensures that the physician database and NPPES system is kept accurate and current. CAQH reattestation to occur every 120 days for all providers.
- Maintains files scans credentials and monitors expiration dates and notifies administrators and Enrollment Manager of deadlines.
- Initiates phone calls generates letters and other correspondence as required for follow up with payers to ensure timely receipt of provider participation effective dates and numbers (goal is within 60 days of payer receipt date of the application). Assures that all contacts and discussion with payers are documented and maintained as well as copies of emails and/or written correspondence sent to third party payers for future reference.
- Reviews and provides research results to the Billing Department to assist with claims issue resolution.
Education Qualifications
- High School Diploma / GED Required
- Associates Degree Preferred
Experience Qualifications
- At least two (2) years Previous experience with insurance verification billing and/or provider relations Required or
- At least two (2) years medical insurance verification/provider relations Required
Skills and Abilities
- Working knowledge of insurance billing/provider operations within a large healthcare organization. (Required proficiency)
- Knowledge of Medicare and Medicaid policies and procedures. (Required proficiency)
- Basic proficiency with MS Word Power Point Excel computer programs (Required proficiency)
- Knowledge of the ECHO NAVINET and CAQH systems (Required proficiency)
- Solid critical thinking / problemsolving skills (Required proficiency)
- Solid analytical and organizational skills. (Required proficiency)
- Ability to collaborate with stakeholders at all levels (Required proficiency)
To carry out its mission CHOP is committed to supporting the health of our patients families workforce and global community. As a condition of employment professionals working onsiteat any CHOP location for any portion of timemust be vaccinated for COVID19. Learn more.
EEO / VEVRAA Federal Contractor Tobacco Statement
Required Experience:
Unclear Seniority
Employment Type
Full-Time
