What are the responsibilities and job description for the Provider Enrollment Specialist/Practice position at Methodist Le Bonheur Healthcare?

If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One!

We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we've served the health care needs of the people of Memphis and the Mid-South.

Responsible for coordinating, monitoring and maintiaing the Credentialing and Re-credentialing processes for the employed providers in relationship to participation with healthcare plans and hospitals for privileges. Facilitates and performs all aspects of credentialing, including appointment, Re-appointment, monitoring and privileging of the MHMH Medical Staff Members and Allied Health Professionals. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence.

A Brief Overview

Responsible for coordinating, monitoring and maintiaing the Credentialing and Re-credentialing processes for the employed providers in relationship to participation with healthcare plans and hospitals for privileges. Facilitates and performs all aspects of credentialing, including appointment,Re-appointment, monitoring and privileging of the MHMH Medical Staff Members and Allied Health Professionals. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

What you will do

Facilitates and performs all aspects of provider enrollment including credentialing and re-credentialing of Physicians and Allied Health.
Professionals in accordance with the policies and procedures of insurance payers.
Tracks and maintains enrollments through timely re-validations.
Performs follow-up with insurance payors.
Establishes providers' CAQH (Council for Affordable Quality Healthcare) profiles. Maintains profiles, uploads documents as required,
and re-attests.
Performs various clerical functions related to the credentialing process.

Education Qualifications

High School Diploma or Equivalent required

Experience Qualifications

Minimum of two years of experience in Provider Enrollment / Credentialing required

Previous experience in provider credentialing with healthcare plans preferred

Substitutions allowed : Two years of college or business training from an accredited school in lieu of one (1) year of experience

Skills and Abilities

Knowledge of insurance payer market as it relates to the Memphis Metropolitan area.

Knowledge of medical and professional credentialing processes including provider enrollment with the various payers and privilege

appointments with various hospitals.

Skill and proficiency with Microsoft Word, Outlook and Excel.

Ability to function with minimal supervision and to relate and communicate effectively with high level Associates within the hospital

and in the community with provider enrollment and their office staffs.

Strong verbal and written communication skills.

Ability to handle assignments independently with demonstrated analytical and interpersonal skills

Demonstrates ability to maintain excellent customer service skills and customer relations under stressful conditions

Ability to set priorities, coordinate multiple tasks, organize tasks, and maintain control of workflow.

Strong organizational skills and must be detail oriented.

Demonstrated deductive reasoning and ability to use reference materials.

Supervision Provided by this Position

There are no supervisory or lead responsibilities assigned to this job.

Physical Demands

The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.

Must have good balance and coordination.

The physical requirements of this position are : light work - exerting up to 25 lbs. of force occasionally and / or up to 10 lbs. of force frequently.

The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.

The conditions to which the Associate will be subject in this position : The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work.

Occasional travel to other facilities.

Our Associates are passionate about what they do, the service they provide and the patients they serve. We value family, team and a Power of One culture that requires commitment to the highest standards of care and unity.

Education :

High School Diploma or Equivalent (Required)

Work Experience :

Credentialing, Provider enrollment with healthcare plans

Certifications :

Boasting one of the South's largest medical centers, Memphis blends a friendly community, a thriving and growing downtown, and a low cost of living. We see each day as a new opportunity to make a difference in the lives of the people in our community.

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Provider Enrollment Specialist/Practice

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