8 Sr Provider Enrollment Specialist - REMOTE Jobs in Lafayette, LA
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Sr Provider Enrollment Specialist - REMOTE
$49k-58k (estimate)
Full Time
7 Days Ago
SCP Health is Hiring a Remote Sr Provider Enrollment Specialist - REMOTE
DescriptionAt SCP Health, what you do mattersAs part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.
Why You Will Love Working Here
To Learn More About SCP Health, Please Visitwww.scp-health.comJoin Our Social Circle
INDJV
Why You Will Love Working Here
- Strong track record of providing excellent work/life balance.
- Comprehensive benefits package and competitive compensation
- Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.
- Prioritize and manage multiple enrollments in a deadline-driven environment.
- Process and maintain both Provider and Group enrollments following Federal and State guidelines.
- Handle high level, complex projects as assigned by Management.
- Distribute, log, receive and scan Provider Enrollment Packets as assigned.
- Update National Provider Database information as needed.
- Monitor credentials, i.e., Medical License, DEA to ensure they are active and in good standing.
- Submit updated credentials to payors when credentials have expired to ensure no lapse in enrollment.
- Serve as the primary contact for providers and payors when questions regarding enrollment/re-enrollment arise.
- Identify any issues with providers eligibility to participate in Government plans.
- Advise Management immediately of any eligibility issues for providers.
- Procure all documents needed from Provider to enroll timely. Escalate to MSL on non-response providers.
- Perform data entry of submitted applications in Provider database record along with any documentation related to the enrollment process.
- Perform follow up on submissions via online, email or phone according to policies and procedures to ensure timely approval is received.
- Monitor Provider Enrollment AR on Hold reports for any held enrollment that should not be holding and identify and research any providers withheld AR of 120 days to ensure no issues exist.
- Report any AROH related issues to Manager upon identification and correction.
- Assist with roster maintenance/training with global partners when needed.
- Update database with new implementation changes when directed by Management.
- Apply critical and strategic thinking in solving any enrollment related issues/concerns.
- Maintain accurate database information and perform data quality cleanup activities as directed by Management.
- Maintain confidentiality of privileged information.
- Work in CAQH database and maintain/update providers’ credentials every 90 days.
- On occasion, may be required to be onsite at client facility to distribute PEPs and help facilitate in person enrollment.
- Once approval is received from payors, document approval and effective dates in Provider Enrollment system to ensure approvals and information are pushed to Billing System for release of claims.
- Monitor changes to payor requirements through payor websites, bulletins, emails, etc. and communicate any changes to appropriate Managers to ensure changes are made wherever applicable.
- Resolve payor related issues and disputes.
- Assist Provider Enrollment Specialists in training, troubleshooting provider and payor issues and leading team when tasked by Supervisor.
- Assist external and internal clients with enrollment related questions and issues.
- HS Diploma required.
- B.A. in Healthcare or Business Administration or equivalent experience preferred.
- PESC (Provider Enrollment Specialist Certification)
- CPCS (Certified Provider Credentialing Specialist)
- Experience working with CredentialStream Software.
- 1 year experience working in a leadership or management role.
- Ability to work without supervision.
- Knowledge and experience of State level Medicaid requirements and both Par and Non-Par Commercial payors.
- Agility in managing multiple, complex priorities.
- Work independently utilizing documented processes and automated daily reported generated from database.
- Strong organizational and time management skills.
- Experience working with Payor Credentialing processes, both Par and Non-Par
- Experience working with Provider Credentials
- High level knowledge of CMS Regulations and guidelines
- Overall working knowledge of software programs with a drive to incorporate technology in all operational functions.
- Experience/Knowledge of CAQH, Availity and other provider related credentialing/enrollment databases.
- Experience working with National Provider Identifier database and processes.
- Experience working with Medicare, Medicaid, or any Commercial payor.
- Strong organizational skills
- Knowledge/understanding of Taxonomy Codes
- Ability to foster a cooperative and respectful work environment.
- Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
- Knowledge of web page access and utilization.
- Ability to communicate effectively both orally and in writing.
- Minimum of 5 years of Provider Enrollment/Payor Credentialing experience required.
To Learn More About SCP Health, Please Visitwww.scp-health.comJoin Our Social Circle
- Check out our LinkedIn Page
- Like us on Facebook
- Follow us on Twitter
INDJV
Job Summary
JOB TYPE
Full Time
SALARY
$49k-58k (estimate)
POST DATE
06/20/2024
EXPIRATION DATE
07/17/2024
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