Provider Enrollment Specialist
Company: West Penn Allegheny Health System
Location: Harrisburg
Posted on: March 19, 2023
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Job Description:
Company :Allegheny Health NetworkJob Description :GENERAL
OVERVIEW:Coordinates and facilitates the enrollment of Allegheny
Clinic professional providers with various payers for professional
services reimbursement. Reviews provider credentialing and/or
recredentialing data for accuracy based on licensing requirements
and various insurer payer requirements. Obtains information from
professional providers and other sources. Completes timely
application processes based on payer specific formats. Continually
follows up on enrollment and/or recredentialing statuses until
complete. Resolves issues as they are identified in a timely
manner. Maintains systems/applications used in the enrollment
processes.ESSENTIAL RESPONSIBILITIES:Completes provider payer
enrollment/credentialing and recredentialing with all identified
payers in a timely manner. Handles highly sensitive and
confidential information regarding professional providers.
(50%)Resolves enrollment issues through collaboration with
physicians, non-physicians, office staff, management, contracting,
insurers, and others as identified. Maintains positive working
relationships with providers. Plays an active role in explaining
and informing providers and practice/office managers of the
submission requirements for credentialing/recredentialing
processes, stressing the importance of compliance with these
processes. (15%)Obtains updated provider information from various
sources including provider offices, state licensing boards,
malpractice insurance companies, residency training programs, etc.
Identifies and resolves problems with primary source verification
elements by interpreting, analyzing, and researching data.
(10%)Proactively obtains updated provider credentialing data prior
to expiration. Creates, develops, and maintains applicable matrices
and/or utilizes departmental software that supports the enrollment
functions. Completes all additions, updates, and deletions.
Supports new provider onboarding processes as related to
enrollment. (5%)Provides updates to on-site practice management
staff and others with any changes to requirements for credentialing
individual providers based on government and commercial payer
credentialing processes. Proactively communicated any changes
regarding contracting as it relates to enrollment and operations.
(5%)Communicates updated payer enrollment information including
payer provider numbers to practice operations in a timely manner
while fostering working relationships and team work with
departments, vendors, etc. (5%)Develops databases and spreadsheets
for tracking organization providers. Ensures data is
accessible/transparent for executive inquiries or other information
as deemed necessary by management. (5%)Continuously searches for
process improvements to achieve accuracy and efficiencies.
(5%)Performs other duties as assigned or
required.QUALIFICATIONS:Minimum2 years experience in a physician
medical practice with a basic understanding of various payer
billing requirements and claims processing or experience with payer
credentialing/enrollment requirementsAdvanced computer skills using
word, excel, adobe and web-based applicationsExcellent customer
service, follow-up, and communication skillsPreferredAssociate's
degreeCertified Provider Credentialing Support (CPCS) by the
National Association Medical Staff ServicesExperience with ECHO
and/or professional provider credentialingDelegated credentialing
experienceExperience with Cactus and/or other professional provider
credentialing softwareDisclaimer: The job description has been
designed to indicate the general nature and essential duties and
responsibilities of work performed by employees within this job
title. It may not contain a comprehensive inventory of all duties,
responsibilities, and qualifications required of employees to do
this pliance Requirement: This job adheres to the ethical and legal
standards and behavioral expectations as set forth in the code of
business conduct and company policies.As a component of job
responsibilities, employees may have access to covered information,
cardholder data, or other confidential customer information that
must be protected at all times. In connection with this, all
employees must comply with both the Health Insurance Portability
Accountability Act of 1996 (HIPAA) as described in the Notice of
Privacy Practices and Privacy Policies and Procedures as well as
all data security guidelines established within the Company's
Handbook of Privacy Policies and Practices and Information Security
Policy.Furthermore, it is every employee's responsibility to comply
with the company's Code of Business Conduct. This includes but is
not limited to adherence to applicable federal and state laws,
rules, and regulations as well as company policies and training
requirements. Highmark Health and its affiliates prohibit
discrimination against qualified individuals based on their status
as protected veterans or individuals with disabilities, and
prohibit discrimination against all individuals based on their
race, color, religion, sex, national origin, sexual
orientation/gender identity or any other category protected by
applicable federal, state or local law. Highmark Health and its
affiliates take affirmative action to employ and advance in
employment individuals without regard to race, color, religion,
sex, national origin, sexual orientation/gender identity, protected
veteran status or disability.Highmark Health and its affiliates
prohibit discrimination against qualified individuals based on
their status as protected veterans or individuals with
disabilities, and prohibit discrimination against all individuals
based on their race, color, age, religion, sex, national origin,
sexual orientation/gender identity or any other category protected
by applicable federal, state or local law. Highmark Health and its
affiliates take affirmative action to employ and advance in
employment individuals without regard to race, color, age,
religion, sex, national origin, sexual orientation/gender identity,
protected veteran status or disability.EEO is The LawEqual
Opportunity Employer Minorities/Women/Protected
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Keywords: West Penn Allegheny Health System, Harrisburg , Provider Enrollment Specialist, Other , Harrisburg, Pennsylvania
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