Credentialing and Provider Enrollment Coordinator

Description

About Balance Health

Balance Health empowers people to live full lives by helping them improve and maintain mobility. We do this by bringing together leading podiatrists, orthopedic surgeons, vascular surgeons, and physical therapists and providing them the tools and resources necessary to deliver exceptional patient care. This mission has made us the fastest growing lower-extremity focused Physician Practice.

Under supervision of the Manager of Credentialing, serve as Credentialing and Provider Enrollment Coordinator, responsible for: 

• Ensuring timely communication with Practice/implementation team to obtain necessary credentialing and provider enrollment information. 
• Administers the provider hospital credentialing process for practice providers and the provider enrollment process for insurance payers. 

Essential Duties and Responsibilities: 

• Process initial and re-credentialing provider applications (Payers, hospitals, surgery centers) 
• Conducts primary source verification with national resources (CAQH, NPPES, etc…) 
• Responsible for credentialing, linking, and revalidating providers and groups with commercial and government insurance payers 
• Responsible for hospital and surgery center initial and recredentialing privileging applications 
• Maintains working knowledge of various provider credentialing and payer credentialing policies and required procedures/forms 
• Responsible for ensuring the department possesses relevant knowledge of enrollment requirements of various health plans and states 
• Responds to and resolves unusual problems or delays in hospital privileging and payer enrollment processes (including claim denials) 
• Ensures accurate PAR list for all providers for contracted payers and provides PAR list to end users as necessary 
• Responds to credentialing unbilled problems as indicated by “holding report” 
• Data entry of provider demographics and payer credentialing linking information in the credentialing software 
• Complete EFT authorization documents to enable payment between client and carrier 
• Demonstrated ability to work effectively with different departments to affect positive change 
• Other duties as assigned 

Requirements

Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities.

• Working knowledge of provider enrollment structure and processes
• Excellent organization abilities
• Excellent written and oral communication skills
• Creative and persistent problem solver
• Attention to detail and accuracy
• Client/service oriented (internal and external)
• Maintain strict confidentiality of sensitive information
• Ability to interact and communicate with individuals at all levels of organization
• Ability to multi-task and prioritize workload in a fast-paced environment
• Ability work in a group setting
• Must be self-motivated with the ability to complete projects independently within established timeframes
• Advanced understanding/knowledge of computer data entry, Microsoft Excel and ability to navigate through any business-related software
• Proficient typing skills

Education and Experience

• Certified Provider Credentialing Specialist (CPCS) preferred
• 3 years in healthcare payer enrollment experience AND credentialing/onboarding within a multi-specialty, medical group,      government enrollment experience required
• Experience in working with Government agencies, CMS and AHCA preferred.

Benefits

• Excellent company paid medical, dental, and vision
• Competitive compensation 
• PTO
• 401k with 4% match
• Remote work stipend
• Company paid short term disability
• Life insurance
• Pet insurance

PHYSICAL DEMANDS/ ENVIRONMENTAL FACTORS

This job description is not designed to cover or contain a comprehensive listing of duties or responsibilities that are required of the employee. Weil Foot & Ankle Institute is proud to be an affirmative action employer and we are committed to an equal opportunity workplace, regardless of race, color, religion, sex, sexual orientation, ender identity, ancestry, citizenship, national origin, marital status, veteran status or disability. If you have a disability or special need that requires accommodation, please let us know.

• While performing the duties of this job, the employee is regularly required to stand or sit; use hands; and talk or hear
• Specific vision abilities required by this job include close vision, distance vision and depth perception

AMERICAN WITH DISABILITIES ACT (ADA) SPECIFICATIONS

Qualified individuals with disabilities may make a request for reasonable accommodation to the Director of Human Resources.  Upon receipt of an accommodation request, the Director of Human Resources will meet with the requesting individual to discuss and identify the precise limitations resulting from the disability and the potential accommodation that might help overcome those limitations. The Director of Human Resources in conjunction with a medical review (and, if necessary, other appropriate management representatives) will determine the feasibility of the requested accommodation and the impact on the business operation.  The Director of Human Resources will inform the qualified individual of the decision of the accommodation request or how to make the accommodation.