Provider Enrollment Specialist

Provider Enrollment Specialist

PeaceHealth is seeking a Provider Enrollment Specialist for a Full Time, 1.00 FTE, Day position. The salary range for this job opening at PeaceHealth is $26.11 – $39.17. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc.

Job Summary

Coordinates provider enrollment service processes for governmental and non-delegated third-party payers for Providers associated with PeaceHealth. Coordinates new department builds, new clinics, applying for NPI's and applying to add new locations to all health plans.

Essential Functions

• Prepares and submits applications for new providers and submits them to PeaceHealth contracted payors and government health plans for the appropriate state.
• Communicates and follows up with providers regarding new provider enrollment, licensing, and DEA requirements for new providers and any changes in location or status of providers, issues and questions.
• Prepares and tracks provider revalidation and recredentialing applications.
• Tracks provider payor approvals.
• Builds a knowledge base for payer requirements and governmental payers regulations.
• Develops working knowledge of payor policies and licensing process for multiple states.
• Offers troubleshooting assistance to all internal departments to solve issues and with providers to complete required enrollment items.
• Maintains OneHealthPort, Provider Source, CAQH, PECOS and NPPES data bases. Maintains CredentialStream for all non-delegated provider types.
• Completes research for denied claims so PFS can release claims for reimbursement.
• Performs other duties as assigned.

Qualifications

Education

• High School Diploma Required: or equivalent and
• Associate Degree Preferred: Or
• Bachelor's Degree Preferred:

Experience

• Minimum of 2 years Required: Experience in provider enrollment or equivalent combination of relevant experience, skills, abilities and education may be acceptable and
• Preferred: Medical terminology and
• Required: Thorough knowledge of CMS (Centers for Medicaid and Medicare Services) and other applicable guidelines and regulations and
• Preferred: Experience with Verity database or other credentialing databases and
• Preferred: Experience with OneHealthPort, Provider Source, CAQH, payer sites

Skills

• Excellent verbal and written communication skills, including knowledge of communication concepts and organizational strategies, particularly as it applies to provider enrollment. (Required)
• Strong organizational and analytical skills. (Required)
• Ability to meet time-sensitive deadlines. (Required)
• Ability to manage multiple priorities, projects and display flexibility in a fast paced and changing work environment. (Required)
• Detail oriented with demonstrated organizational ability. (Required)
• Proficient computer skills in Windows, Microsoft Word, Access, Excel and PowerPoint. (Preferred)

Working Conditions

Lifting

• Consistently operates computer and other office equipment.
• Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects.
• Sedentary work.

Environmental Conditions

• Predominantly operates in an office environment.
• Some time spent on site in medical/hospital setting.

Mental/Visual

• Ability to communicate and exchange accurate information.
• The worker is required to have close visual acuity to perform an activity such as: preparing and analyzing data and figures; transcribing; viewing a computer terminal; extensive reading.

PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.

See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility.

For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.