Provider Enrollment & Credentialing Specialist

Overview

AltaPointe Health Systems is a comprehensive behavioral healthcare and psychiatric hospital system. Our continuum of care includes two psychiatric hospitals, multiple federally qualified health centers, multiple behavioral health and primary care outpatient locations, and residential services. This position is responsible for managing the enrollment and re-enrollment application process for all AltaPointe Health System providers with all applicable commercial, federal, and state payer plans. 

Responsibilities

Responsible and accountable for all functions relating to the administrative work in coordinating the enrollment and re-enrollment process.

• Completes accurate enrollment application for new providers in a timely manner.
• Maintains accurate information with regards to the re-enrollment standards for all payers.
• Submits re-enrollment applications in a timely manner to ensure that providers are up to date with their re-enrollment status.
• Follow up with the contractual insurance carriers regarding provider/facility enrollment/termination/relocation status.
• Enroll all providers in CAQH and provide re-attestations as needed.

Maintains the Credentialing Software Database

• Issues monthly reports from the Credentialing Software Database to ensure proper communication regarding provider status related to enrollment.
• Provides additional status reports and updates as needed.
• Updates the appropriate provider enrollment matrix.
• Tracks progress of outstanding applications and informs the appropriate parties of in network effective dates.

Communicates with internal management, providers, and departments in regards to the enrollment process

• Proactively communicates with Human Resources in regards to the needs/requirements of the enrollment department as it relates to provider information.
• Works closely with providers to obtain necessary documentation.
• Assists providers in obtaining/updating an NPI number.

Coordinates with the billing department

• Collaborates with the billing department to resolve any provider based denial issues related to the enrollment process.
• Communicates with appropriate billing staff regarding the status of a provider’s enrollment with individual payers. Any significant delays must be reported to management
• Assists with the maintenance of the Practitioner Enrollment forms in all Electronic Health Records in a timely manner.

Courteous and respectful towards patients, visitors, and co-workers

• Treat patients with care, dignity, and compassion
• Respect patients’ privacy and confidentiality
• Is pleasant and cooperative with others
• Assist patients and visitors as needed.
• Personal values don’t inhibit ability to relate and care for others
• Is sensitive to the patient’s needs, expectations and individual differences.
• Is gentle and calm with patients, families, and others as appropriate.

Administrative and Other Related Duties as assigned:

• Actively participate in Performance Improvement activities
• Actively participate in AHS committees as requested
• Complete assigned tasks in a timely manner
• Follow AHS policies and procedures
• Receive and respond to inquiries of billing matters promptly and courteously.
• Assist with performance of duties of other staff in periods of absence.
• Perform other duties as assigned by supervisor.

Qualifications

Associate’s degree in business or related field. Three to five years of related work experience may be used in lieu of education requirement. A minimum of three years prior experience in the provider enrollment, credentialing, or billing field is required. Applicant must demonstrate problem solving skills and work in a fast paced environment with a flexible attitude. Applicant must have working knowledge of MS Office: Excel, Word, etc. Applicant must have excellent verbal and written communication skills. Proficiency in database management is plus.