Payor and Provider Enrollment Coordinator

Building Location:Support Services Center - Fargo

Department:48600 Physician Services

Job Description:Responsible for ensuring all healthcare practitioners/facilities are properly credentialed/enrolled with all contracted insurance networks and subnetworks. Understands CMS Medicare, Medicaid, and managed care billing, credentialing and enrollment requirements and reimbursements methodologies and applies knowledge to identify, quantify, and address missing/incorrect charges. Assist in the development of resources for researching issues.

Education Qualifications:

Key Responsibilities:

• Responsible for organizations including applications and credentialing for various practitioner’s groups and specialties for which contracting services are provided
• Completes audit of signed enrollment applications and required documentation for completeness and accuracy
• Maintains and updates all credentialing systems with current information for all physicians/providers
• Responsible for coordinating and maintaining all credentialing documents necessary to complete credentialing and re-credentialing of all physicians/providers/ facilities contracted with Essentia Health
• Actively participates in group leadership meetings and is accountable for presenting credentialing status for all groups
• Resolve problems, questions, and issues internally, as well as at the payor and the practice
• Coordinates and facilitates troubleshooting with payor networks to resolve any issues related to enrollments
• Acts as a liaison between Business/Revenue Services, Contracting, EPIC and Payors

Educational Requirements:

• High School Diploma plus previous work experience or education

Required Qualifications:

• 2 years’ experience in an office setting, preferably health care, insurance, or business services
• Experience researching issues, thinking critically, learning, and following processes, meeting multiple ongoing deadlines, and interpreting and understanding policies, rules and regulations
• Extensive knowledge and experience with Excel, Outlook, Microsoft office products and software programs; shows ability to learn/use software programs
• Excellent verbal and written communication skills and attention to detail

Preferred Qualifications:

• Experience with payer portals including CMS I&A, PECOS, MPSE, MMIS, Forward Health, CAQH, etc. preferred but not required

Licensure/Certification Qualifications:

Certification/Licensure Requirements:

• Provider Enrollment Specialist Certificate (PESC) or ability obtain within 6 months of employment Minimum Experience

FTE:1

Possible Remote/Hybrid Option:

RemoteShift Rotation:Day Rotation (United States of America)

Shift Start Time:

Shift End Time:

Weekends:

Holidays:No

Call Obligation:No

Union:Union Posting Deadline: