SR Provider Enrollment Coordinator

Who We Are

JPS Health Network is a $950 million, tax-supported healthcare system in North Texas. Licensed for 582 beds, the network features over 25 locations across Tarrant County, with John Peter Smith Hospital a Level I Trauma Center, Tarrant County's only psychiatric emergency center, and the largest hospital-based family medical residency program in the nation. The health network employs more than 7,200 people.

Acclaim Multispecialty Group is the medical practice group featuring over 300 providers serving JPS Health Network. Specialties range from primary care to general surgery and trauma. The Acclaim Multispecialty Group formed around a common set of incentives and expectations supporting the operational, financial, and clinical performance

outcomes of the network. Our goal is to provide high quality, compassionate clinical care for every patient, every time.

Why JPS?

We're More Than a Hospital. We're 7,200 Of The Most Dedicated People You Could Ever Meet. Our Goal Is To Make Sure The People Of Our Community Get The Care They Need And Deserve. As Community Stewards, We Abide By Three Rules Of The Road

• Own it. Everyone who wears the JPS badge contributes to our journey to excellence.
• Seek joy. Every day, every shift, we celebrate our patients, smile, and emphasize positivity.
• Don't be a jerk. Everyone is treated with courtesy and respect. Smiling, laughter, compassion - key components of our everyday experience at JPS.
  
  

When working here, you're surrounded by passion, diversity, and dedication. We look forward to meeting you!

For more information, visit www.jpshealthnet.org .

To view all job vacancies, visit www.jpshealthnet.org , www.jpshealthnet.org/careers , or www.teamacclaim.org .

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Job Title

SR Provider Enrollment Coordinator

Requisition Number

40073

Employment Type

Full Time

Division

ACCLAIM ADMIN SERVICES

Compensation Type

Hourly

Job Category

Business / Professional

Hours Worked

M-F 8AM-5PM

Location:

Acclaim Magnolia

Shift Worked

Day

Job Description

Job Summary: The Sr. Provider Enrollment Coordinator supports in the daily activities of the managed care department with respect to the enrollment of employed physicians and insurance plan credentialing of employed physicians and other assigned practitioners. This position supports the Credentialing Manager in tracking and managing provider enrollment application submissions and coaching and developing the Provider Enrollment Coordinators. This position develops and maintains positive relationships with managed care organizations and serves as a point of contact regarding health plan enrollment.

Essential Job Functions & Accountabilities

• Manages the completion and submission of provider enrollment or credentialing applications.
• Monitors the team's provider enrollment submissions and follows-up to provide coaching and development to peers in order to ensure provider numbers are established timely and linked to Acclaim Physician Group.
• Provides training and direction to new team members.
• Leads team projects and is accountable for ongoing objectives.
• Understands specific application requirements for each payer including but not limited to; required pre-requisite forms, supporting documentation (DEA, License, CV, COI, etc.) and regulations.
• Works closely with practitioners to expedite completion of forms and requirements including obtaining signatures.
• Prepares and oversees the payer delegated credentialing audits as required by NCQA.
• Maintains practitioner enrollment information within the credentialing database.
• Processes all applications for practitioner re-credentialing with insurance plans.
• Completes all CAQH’s and CAQH re-attestations, online applications and re-enrollment applications.
• Establishes and maintains practitioner National Provider Identifier (NPI) registration and NPPES information database.
• Retains records related to completed enrollment applications.
• Responds to all internal and external inquiries with a prompt resolution.
• Oversees the practitioner termination process with insurance plans including adding and changing new or existing practitioner information.
• Maintains documentation and reporting regarding the enrollment process.
• Communicates practitioner demographics and information by the insurance plan to Acclaim Revenue Cycle team.
• Provides appropriate report and statistical data to other department designees for review, follow-up and resolutions.
• Manages workload to meet deadlines and maintains department standards on turnaround time to insure timely insurance plan effective dates.
• Provides weekly status reports for director and management review.
• Job description is not an all-inclusive list of duties and may be subject to change with or without notice. Staff are expected to perform other duties as assigned.
  
  

Qualifications

Required Qualifications:

• High School diploma, GED or equivalent.
• 7 plus years of healthcare provider enrollment experience to include CMS Medicare Provider Enrollment and Texas Medicaid Provider Enrollment.
• Experience with (NCQA) National Committee for Quality Assurance regulations, CMS, Federal and State.
  
  

Preferred Qualifications:

• 3 plus years of college with management emphasis.
• CPCS Certification.
  
  

Location Address:

200 W. Magnolia

Fort Worth, Texas, 76104

United States