Enrollment Specialist

Enrollment Specialist

The Enrollment Specialist is responsible for auditing credentials verifications compliant with NCQA Accreditation standards and is directly responsible for payer enrollment of organizational facilities, service locations, professional groups, physicians, practitioners, and other billing providers where required in order for the organization to receive payment for services. This position is accountable for maintaining and disseminating accurate plan participation status to operational and billing internal departments to maximize collections in the revenue cycle management process. Function as a subject matter expert for payer credentialing and enrollment representatives to ensure health system providers are fully credentialed and loaded as participating providers with all applicable government and commercial payers.

Monument Health offers competitive wages and benefits on qualifying positions. Some of those benefits can include:

• Supportive work culture
• Medical, Vision and Dental Coverage
• Retirement Plans, Health Savings Account, and Flexible Spending Account
• Instant pay is available for qualifying positions
• Paid Time Off Accrual Bank
• Opportunities for growth and advancement
• Tuition assistance/reimbursement
• Excellent pay differentials on qualifying positions
• Flexible scheduling

Essential Functions:

• Directly responsible for oversight and collection of accurate credentialing of organizational providers, facilities and ancillary services.
• Oversight and collection of documentation necessary for payer enrollment of complex hospital groups and services compliant with hospital system policies and accreditation sources such as NCQA, CMS and others.
• Ensure compliance with applicable regulatory requirements, accreditation standards, payer policies, and governing documents.
• Obtain application signatures from the authorized signatory and provide all required supporting documentation. Submit applications and follow up diligently to ensure timely processing. Respond to deficiency notifications in a timely manner. Follow up diligently on provider addition requests and communicate provider changes, corrections, and terminations. Continuously monitor enrollment process for improvements. Collaborate with Legal and Accreditation to ensure regulatory and compliance requirements are met.
• Responsible for delegated credentialing policy interpretation and compliance. Responsible for annual payor credentialing file audits. Oversees delegated credentialing roster submission and tracking. Work with delegated payer contacts to address concerns within the delegation process while cultivating relationship with delegated payers.
• Works collaboratively with Medical Staff Services team to promote data integrity and to optimize effectiveness of the Credentialing database, ensuring consistency in data entry rules. Supports the implementation of new database modules applicable to Medical Staff Services. Implementation includes data migration and validation, as well as data mapping to demographic reports, participation reports, and training.
• Provides training related topayer enrollment that enhances knowledge, develop skills and enrich the team.
• Excellent interpersonal skills and ability to work efficiently with internal and external customers. Maintain positive working relationships with payer representatives, providers, and all Monument Health internal departments.
• All other duties as assigned.

Additional Requirements:

Required :

Education - High School Diploma/GED Equivalent in General Studies

Experience Minimum 1 year of healthcare experience (i.e. Credentialing/Enrollment, Billing/Collections, Business Office)

Preferred :

Education - Associates or Bachelor's degree in Healthcare or Business

Physical Requirements:Sedentary work - 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, including the human body. Sedentary work involves sitting most of the time.

Job Category

Business Administration

Job Family

Business Services

Shift

Requires the ability to work assigned schedules and hours as determined by the department

Employee Type

Regular