Enrollment and Credentialing Specialist and Business Office Associate

Full-time. Weekday shifts. Possible weekend coverage.

The Enrollment and Credentialing Specialist and Business Office Associate will be responsible for duties associated with provider enrollments and credentialing. This position will also serve as relief and backup support for the patient services associates at the main and ER reception desk. Additionally, this role will be responsible for serving as backup for medical records.

Must maintain the confidentiality of all patient, resident, and facility information at all times, both while on and off duty.

Previous knowledge or experience with health care provider credentialing, enrollments or billing is desired. Maintains confidentiality of all information and company documents. Speaks clearly and concisely. Must have excellent interpersonal and written communication skills. Able to read and interpret written information. Responds promptly and in a professional manner to all requests for enrollment documentation and/or questions. Must be a self-starter with the ability to work independently and as part of a team. Good decision-making, analytical, and problem-solving skills are required as well as high attention to detail. Ability to adhere to strict deadlines, performance standards, and quality measures. Computer proficiency with Word, Excel, Outlook, and the use of data management systems is necessary.

Essential Functions, Roles, and Responsibilities

1. Responsible for oversight of provider enrollments for insurance credentialing and updates for SMC providers and locum coverage.
   • Responsible for obtaining and coordinating all necessary provider enrollment applications for billing to government and commercial payers. Also, responsible for revalidating providers and groups with government and contracted payers
   • Enters practitioner information into enrollment databases such as PECOS and/or various enrollment portals and ensures that the information in the databases is current and accurate.
2. Creates and maintains CAQH profile and ensures contracted payers receive updated informationand facilitates provider re-attestations of CAQH data as required by CAQH.
   • Prepares initial and/or re-enrollment application packets, on behalf of the practitioner.
   • Ensures the enrollment packets are appropriately signed, complete and accurate, and submitted to the payer with necessary attachments.
   • Coordinates re-enrollment dates and sends out application packets for all practitioners who require re-enrollment.
   • Tracks all steps taken in the enrollment process and logs the actions in the credentialing database.
   • Monitors the pending credentialing claim report and takes any necessary action (which may include sending additional enrollment applications to the payer) to allow claims to be submitted for payment.
   • Communicates with various payers, clinics, billing offices, practitioners, and leadership regarding the status of enrollments on an ongoing basis as the primary contact for all enrollment issues.
   • Work with internal billing team to share approvals and work through denials and appeal processes
3. Responsible for the ongoing credentialing, re-credentialing and privileging activities of all providers including medical staff, courtesy staff, locums, and telemedicine providers for the facility.
   • Facilitate all aspects of the credentialing process including initial appointment, ongoing tracking and updates, and reappointment.
   • Coordinates, monitors, and maintains the credentialing and re-credentialing process of the physicians in our hospital.
   • Responsible for maintaining meticulous and up-to-date credentialing records.
   • Evaluate records to ensure adherence to state regulations governing education and professional licensure, as well as maintaining records and proof of the paperwork associated with compliance.
4. Front receptionist support and backup coverage. Will be responsible for filling in for front receptionist (main reception desk and ER) when needed. This includes coverage for breaks, time off or open shifts.
   • Performs receptionist functions at the front desk and ER desk of the hospital to include:
     • Greets all persons entering the hospital and directs them to the appropriate area, office or person.
     • Answers telephone appropriately, and messages are routed to appropriate personnel.
   • Performs admission procedures for all patients according to established guidelines.
     • Responsible for gathering correct patient information at the time patient is admitted to the hospital.
     • Responsible for typing all patient information into the computer system.
   • Responsible for the collection of copayments according to established guidelines.
5. Medical Records backup coverage. Will be responsible for filling in for medical records when needed.
   • Must demonstrate a complete understanding of the release of information process, including guidelines in department policies and procedures, HIPAA policies and procedures and other regulatory documents regarding the release of protected health information.
   • Handle all requests and inquiries for patient information, dispersing the information with accountability to all regulatory entities and according to the department and HIPAA policies and procedures.

Compensation and Benefits We offer a competitive starting wage, with credit for experience. Benefits include health, dental, vision, and life insurance; paid time off (PTO); extended sick leave; 401(k) with match; discount policy; voluntary benefits; and more{target="_blank"}