Position Summary:

Responsible for the day-to-day payer enrollment service tasks to include payer enrolment, revalidations, and other miscellaneous tasks as required by payers.  Serves as the initial point of contact for employed and contracted providers, 3^rd party payers, and other enrollment vendors.  Assist with policy and procedure review and development, where needed.

 

ESSENTIAL FUNCTIONS

 

·       Work with employed and contracted providers to meet all their payer enrollment credentialing needs outlined in their contract.  Maintaining strict confidentiality for matters pertaining to provider enrollment.

 

·       Knowledge of provider credentialing/accreditation/insurance regulations, policies, guidelines, and standards.

 

·       Completes the processes to enroll and credential providers; i.e., physicians, advanced allied practitioners, etc. with all 3^rd party payers adhering to payer requirements and deadlines.

 

·       Completes and processes to recredential existing providers.

 

·       Gather and maintain current data and documents for all providers in an organized and complete fashion.

 

·       Clearly and effectively communicates with providers, physician practice leaders and insurance companies handling questions and resolving issues.

 

·       Review and update, if necessary, health plan directories, websites, agencies, and other appropriate entities for current and accurate provider information.

 

·       Maintains scheduling grid so dissemination of information to clinics is timely and accurate.

 

·       Monitors when credentials are expiring, making sure all providers meet accreditation and regulatory standards.

 

·       Assists with development, planning and implementation of processes.

 

·       Prepares statistical reports and performs clerical functions such as preparing and sending outgoing mail, distributing incoming mail, maintaining file systems, entering data, and maintaining databases, typing documents and correspondence.

 

·       All other job duties as assigned.

Minimum Education:

 

·       High School Diploma or GED Required.

 

Required Qualifications:

 

·       Two (2) years’ experience in credentialing, privileging, or other medical experience relevant to insurance carrier credentialing, re-credentialing and follow-up preferred.

About St. Francis-Emory Healthcare

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