What are the responsibilities and job description for the Provider Enrollment Specialist position at Skagit Regional Health?
Department : Revenue Cycle SRH
Exempt : No
Schedule : DAYS
Position Type : Full Time 0.6 FTE or More
FTE : 1.000000
Base Wage : $ 22.61 to $ 33.92
Location : SRH Business Center
The information described in this job description has been designed to indicate the general nature of the work performed. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this job.
Other information : Job Summary
The PES is detail-oriented and proactive in completing tasks. The PES will play a crucial role in ensuring the enrollment and credentialing of healthcare providers with various insurance plans and government programs. The PES is responsible for payer, provider, and facility enrollment as well researching billing and denial issues that may arise because of provider enrollment issues. Additionally, this position will utilize a variety of proprietary and external tools in order to research and resolve provider enrollment issues. This may require contact with the Hospital Coordinators, operation personnel and / or insurance companies via phone, email or website. There may be other meaningful duties as assigned. This position offers an opportunity to work in a dynamic healthcare environment, collaborating closely with providers, insurance agencies, and internal departments to facilitate timely enrollment and credentialing processes. Works effectively and cooperatively within the workplace. Location / Department specific tasks and competencies may apply.
Essential Functions
Manage the provider enrollment process for new and existing healthcare providers.
Prepare and submit accurate enrollment applications and credentialing documents to insurance companies, Medicare, Medicaid, and other relevant entities.
Responsible for credentialing delegation oversight. Ensure that delegated entities submit required documents on schedule and follow-up as required.
Works closely with external payer credentialing vendor on notification of a provider's start, welcome packets, provider documentation and ensuring the provider is in all systems.
Maintain up-to-date knowledge of enrollment requirements and regulations for different insurance plans and government programs.
Communicate effectively with providers to gather necessary information and ensure completeness of enrollment applications.
Collaborate with internal departments such as Billing, Finance, and Compliance to resolve enrollment-related issues and ensure compliance with organizational and regulatory standards.
Track and monitor enrollment statuses, follow up on outstanding applications, and escalate issues as needed to expedite the enrollment process.
Maintain detailed records and documentation related to provider enrollment activities.
Researches and resolves billing vendor holds from insurance carriers forwarded to Skagit Regional Health by the external billing vendor using a variety of methods dependent on the reasons.
Maintain ability to effectively utilize Microsoft Office (Outlook) and department specific software applications to perform work.
Communicate effectively and cooperatively in the workplace.
Actively contribute to the achievement of Quality Improvement and Lean Process Improvement activities.
Complete all mandatory learning requirements in a timely manner.
Attend and actively participate in all department, team and / or committee meetings.
Comply with all Skagit Regional Health, department and location specific policies and procedures.
Perform other duties as assigned by Supervisor or designee.
Education
High School Diploma or GED required. Bachelor's degree in Healthcare Administration, Business Administration, or a related field preferred.
Experience / Training
Previous experience in provider enrollment, delegated credentialing, or healthcare insurance verification highly desired. Strong understanding of healthcare insurance plans, Medicare, Medicaid, and managed care organizations.
License / Certifications
None required.
Other Skills
Excellent organizational skills with the ability to manage multiple priorities and meet deadlines. Exceptional attention to detail and accuracy in data entry and documentation. Proficient in using computer applications and databases; experience with enrollment software is a plus. Strong interpersonal and communication skills to interact effectively with providers and internal stakeholders. Must be an organized "self-starter" requiring little supervision in order to focus on and accomplish tasks.
Physical Demands and Work Environment
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit for long periods of time; when working in office. Repetitive tasks such as typing, sitting, answering phones, and interacting with computers and computer systems most of the day is a function of the position. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to focus. This position requires working in an indoor, environmentally controlled environment when in the office.
Skagit Regional Health offers a comprehensive benefit package including medical, dental, vision, 457b / 401a (retirement), long term disability, and paid time off to all employees holding an FTE of 20 or more hours per week. Eligible employees also receive sick time pay.
Salary : $23 - $34
