System Payor Enrollment Specialist (Full-time; Days)

Your job is more than a job This job description is intended to describe the general nature and level of work performed by employees assigned to this department. This is not an exhaustive list of all duties and responsibilities, and LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary. General Duties Payor Enrollments: Facilitate the enrollment and credentialing/re-credentialing process with various payers, to include but not limited to Medicare, Medicaid, and Commercial Insurance Plans. Technical: Manages the credentialing and re-credentialing process as well as assist providers with accurate completion of enrollment process to ensure deadlines are met. Ensures timely credentialing is done for new providers with each payer and notify physicians, scheduling and billing offices of incomplete credentialing and expected approval date to ensure clean billing. Engages in communicating with payor representatives to ensure completion and revalidation requests have been completed and participation dates are accurate. Maintain electronic files related to applications submitted, approval notifications, and all other supporting provider documentation that may be needed for payor enrollments. Maintain up-to-date knowledge of payor regulations, guidelines, and requirements to ensure NCQA (National Committee for Quality Assurance) compliance. Collaborate with internal stakeholders, including billing and coding teams, to resolve payor-related issues and streamline processes. Perform thorough verification and validation of provider information to prevent enrollment delays and billing errors. Ensure the ongoing accuracy and completeness of provider profiles within the CAQH (Council for Affordable Quality Healthcare) and internal systems. Stay informed about changes in healthcare policies, reimbursement rates, and coding standards that may impact payor enrollment. Develop and maintain strong relationships with payor representatives to expedite and troubleshoot enrollment processes. Conduct regular updates to provider directories and perform quarterly maintenance activities. Participate in training sessions and workshops to enhance knowledge and skills related to payor enrollment and healthcare regulations. Cooperates with others to balance the workload and meet project deadlines of the department. Utilize knowledge of enrollment processes in multiple states and stay current with state-specific regulations. Analytics: Keeps management updated on status of payor enrollment and/or any matters requiring attention via scheduled documented reporting. Generates and monitors monthly/periodic provider reports to determine outstanding claims, payor enrollment status, status of providers and other credentialing data. Collaboration: Collaborates with medical staff office as well as cross-functional team members to record updates to ensure credentialing process is smooth and claims are processes correctly. Ensures smooth functioning of the physician practice plan to ensure updates are received when/if credentialing is delayed. Experience / Education Qualifications High School Diploma/GED or equivalent OR 2 years of experience in administrative support, insurance enrollment, payer credentialing, billing, or like field. Knowledge, Skills, and Abilities Input data accurately into appropriate system and maintain records/database to ensure up-to-date information. Excellent organizational skills, oral and written skills. Ability to follow-up on pending items and critical thinking. Ability to act independently and ability to maintain confidentiality. Competency in Microsoft Office, specifically Excel, Outlook, PowerPoint and Word. Ability to take and transcribe minutes. Reporting Relationships Does this position formally supervise employees? No Functional Demands Light: Light physical requirements- Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible. Physical Demands Sitting - Continuous (67-100% of day) Standing - Occasional (0-35% of day) Walking - Occasional (0-35% of day) Climbing (e.g., stairs or ladders) - Occasional (0-35% of day) Lifting Floor to waist level: 0-10lbs - Occasional (0-35% of day) Lifting Floor to waist level: 10-20lbs - Occasional (0-35% of day) Lifting Floor to waist level: 20-50lbs - Occasional (0-35% of day) Lifting Floor to waist level: 50-100lbs - Occasional (0-35% of day) Lifting Floor to waist level: 100+lbs - Occasional (0-35% of day) Lifting Waist level and above: 0-10lbs - Occasional (0-35% of day) Lifting Waist level and above: 10-20lbs - Occasional (0-35% of day) Lifting Waist level and above: 20-50lbs - Occasional (0-35% of day) Lifting Waist level and above: 50-100lbs - Occasional (0-35% of day) Lifting Waist level and above: 100+lbs - Occasional (0-35% of day) Carrying objects - Occasional (0-35% of day) Push/pull - Occasional (0-35% of day) Twisting - Occasional (0-35% of day) Bending - Occasional (0-35% of day) Reaching forward - Occasional (0-35% of day) Reaching overhead - Occasional (0-35% of day) Squat/kneel/crawl - Occasional (0-35% of day) Wrist position deviation - Frequent (36-66% of day) Pinching/fine motor activities - Frequent (36-66% of day) Keyboard use/repetitive motion - Continuous (67-100% of day) Talk or hear - Continuous (67-100% of day) Sensory Requirements Near Vision - Very Accurate 20/20 Far Vision - Very Accurate 20/20 Color Discrimination - Yes Depth Perception - Accurate Hearing - Accurate Organizational Exposure Risk Potential Bloodborne pathogens - Not Anticipated Chemical - Not Anticipated Airborne communicable diseases - Not Anticipated Extreme temperatures - Not Anticipated Radiation - Not Anticipated Uneven surfaces or elevations - Not Anticipated Extreme noise levels - Not Anticipated Dust/particular matter - Not Anticipated Other (List) - Not Anticipated Population Served Neonate/Infant up to 1 year: No Youth (1yr to 15 yrs): No Adult (16 and up): No Work Shift Days (United States of America) LCMC Health is a community. Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little “come on in” attitude is the foundation of LCMC Health’s culture of everyday extraordinary Your Extras Deliver healthcare with heart. Give people a reason to smile. Put a little love in your work. Be honest and real, but with compassion. Bring some lagniappe into everything you do. Forget one-size-fits-all, think one-of-a-kind care. See opportunities, not problems – it’s all about perspective. Cheerlead ideas, differences, and each other. Love what makes you, you - because we do You are welcome here. The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary. LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law. To expedite the hiring process, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States. #J-18808-Ljbffr LCMC Health