Senior Provider Enrollment Specialist, Day Shift, Managed Care

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Additional Information

Support Center If you are a current Adventist HealthCare employee, please click this link to apply through your Workday account. Adventist HealthCare seeks to hire an experienced Senior Provider Enrollment Specialist for our Managed Care Department who will embrace our mission to extend God's care through the ministry of physical, mental, and spiritual healing. As a Senior Provider Enrollment Specialist, you will: - Responsible for overseeing, monitoring, and maintaining the processes involved in both initial and revalidation of payer enrollment applications. - Including for AHC facility enrollment. - Possess a thorough comprehension of payer enrollment requirements and regulations governing enrollment to ensure ongoing compliance. - Responsible for securing timely enrollment by submitting applications ahead of deadlines and maintaining consistent follow-up with payers through completion. - Conduct research and document enrollment processes encompassing, but not limited to, initial enrollment, revalidation, and demographic changes. - Regularly update and manage data in the credentialing database, spreadsheets, and folders, while maintaining data integrity. - Assures compliance with payer requirements as related to the provider enrollment and monitor activities to ensure compliance with all procedures and regulations. - Participate in the development and implementation of payer enrollment processes and procedures and provide input regarding process improvement. - Serve as primary contact for payer inquires and issue resolution, specifically related to enrollment and credentialing matters. Including obtaining provider numbers for billing. - Performs other duties as assigned. - Submitting information to IT to load provider numbers and effective dates to billing systems. - Update CIN members' information for the portal. - Collaborate with the Medical Staff Office to address questions, provide updates, and participate in meetings related to provider onboarding, ensuring alignment with organizational policies and payer requirements in accordance with NCQA standards for delegated credentialing. - Actively engage with payers on issues related to enrollment or claims denied for credentialing. Generate and prepare monthly provider reports of new, updated, and terminated providers for delegated payers. - Collaborate with Provider Recruitment on new service lines and provider onboarding. - Track agreement participation for AHC's CIN network and oversee delegated credentialing rosters and audits. - Maintain and apply for National Provider Identification (NPI) numbers for entities. Qualifications include: - Proficiency in Microsoft Office (Excel, Word, Outlook, PowerPoint and Access) - Ability to work independently, prioritize, and manage multiple tasks. - Collaboration skills to work across the organization with key stakeholders. - Working knowledge of payer credentialing, CAQH, ePREP, CMS, etc. - Excellent critical thinking skills - Strong customer service and professional demeanor. - Good verbal and written communication skills. - Strong stewardship of confidential data. - Possess and continuously demonstrate good/sound professional judgment, understanding when and what requires escalation. - Open and receptive to changes that occur. Providing good feedback on issues of concern and working with the team to implement changes. - Receptive and willing to obtain additional training provided and participate in any associations specific to Payer. - Bachelor's degree, preferably in Healthcare or Business Administration or 7 to - 10 years working experience with provider credentialing and/or enrollment. Work Schedule: Employment Type: Full-time Hours per Week: 40 hrs/week Typical Daily Schedule: 8:30 am- 5 pm Monday through Friday Shift Type: Day Shift-Hybrid Schedule Holiday Requirements: Follow the company holiday calendar Pay Range: $71,932.12 - $107,889.60 If the salary range is listed as $0 or if the position is Per Diem (with a fixed rate), salary discussions will take place during the screening process. Under the Fair Labor Standards Act (FLSA), this position is classified as: United States of America (Exempt) At Adventist HealthCare our job is to care for you. We do this by offering: Work life balance through nonrotating shifts Recognition and rewards for professional expertise Free Employee parking Medical, Prescription, Dental, and Vision coverage for employees and their eligible dependents effective on your date of hire Employer-paid Short & Long-Term Disability, Basic Life Insurance and AD&D, (short-term disability buy-up available) Paid Time Off Employer retirement contribution and match after 1-year of eligible employment with a 3-year vesting period Voluntary benefits include flexible spending accounts, legal plans, and life, pet, auto, home, long term care, and critical illness & accident insurance Subsidized childcare at participating childcare centers Tuition Reimbursement Employee Assistance