Provider Enrollment Specialist I

At SCP Health what you do matters

As part of the SCP Health team you have an opportunity to make a difference. At our core we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients 7500 providers 30 states and 400 healthcare facilities SCP Health is a leader in clinical practice management spanning the entire continuum of care including emergency medicine hospital medicine wellness telemedicine intensive care and ambulatory care.

Why you will love working here:

- Strong track record of providing excellent work/life balance.

- Comprehensive benefits package and competitive compensation.

- Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration courage agility and respect.

Primary Duties and Responsibilities:

• Process and maintain provider applications for enrollment and re-enrollment for Medicare Medicaid BCBS and/or Commercial payors in accordance with Federal and State guidelines.
• Prioritize and manage multiple enrollments in a deadline-driven environment.
• Distribute log receive and scan Provider Enrollment Packets as assigned.
• Update National Provider Database information as needed.
• Monitor credentials i.e. Medical License DEA to ensure they are active and in good standing.
• Submit updated credentials to payors when credentials have expired to ensure no lapse in enrollment.
• Serve as the primary contact for providers and payors when questions regarding enrollment/re-enrollment arise.
• Identify any issues with providers eligibility to participate in Government plans.
• Advise Supervisor/Manager immediately of any eligibility issues for providers.
• Procure all documents needed from Provider to enroll timely. Escalate to MSL on non-response providers.
• Perform data entry of submitted applications in Provider database record along with any documentation related to the enrollment process.
• Perform follow up on submissions via online email or phone according to policies and procedures to ensure timely approval is received.
• Maintain accurate database information and perform data quality cleanup activities as directed by Management.
• Maintain confidentiality of privileged information.
• Work in CAQH database and maintain/update providers credentials every 90 days.
• On occasion may be required to be onsite at client facility to distribute PEPs and help facilitate in person enrollment.
• Once approval is received from payors document approval and effective dates in Provider Enrollment system to ensure approvals and information are pushed to Billing System for release of claims.
• Monitor changes to payor requirements through payor websites bulletins emails etc and communicate any changes to appropriate Managers to ensure changes are made wherever applicable.

Required Skills and Qualifications:

• Work independently utilizing documented processes and automated daily reports generated from database.
• When payor requirements change must be able to analyze and compare processes in order to recommend process solutions to Management.

• Agility in managing multiple priorities with strong organizational and time management skills.
• Knowledge of Payor Credentialing processes both Par and Non-Par.
• Knowledge of Provider Credentials.
• Experience working in CAQH database and National Provider Identifier database
• Knowledge of CMS Regulations and guidelines.
• Proficient in Microsoft Office applications including Word and Excel.
• Ability to foster a cooperative and respectful work environment.
• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
• Ability to communicate effectively both orally and in writing.
• Minimum 3 years of Provider Enrollment/Payor Credentialing experience required.

Preferred Skills and Qualifications:

• Experience with Availity and other provider related credentialing/enrollment databases.
• Experience working with Medicare Medicaid or any Commercial payor.
• Experience working with Credentialing/Enrollment software.

EDUCATION:

• HS Diploma required.
• 2 years college or equivalent experience preferred.

FIELD OF STUDY:

• Healthcare Administration
• Business Administration

CERTIFICATES AND LICENSES: (Preferred)

• PESC (Provider Enrollment Specialist Certificate)
• CPCS (Certified Provider Credentialing Specialist)

PRIMARY LOCATION:

• Lafayette LA

Pay Range:

This range represents the anticipated base salary for this role. Actual compensation will be determined based on experience qualifications and internal equity considerations.

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We offer a comprehensive benefits package designed to support your health financial well-being and work-life balance including medical dental vision insurance a 401(k) plan with a company match paid time off and holidays professional development support and employee wellness resources.

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