Provider Enrollment Coordinator

At Children’s Wisconsin, we believe kids deserve the best.

Children’s Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputation draws patients and families from around the country.

We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us achieve our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day, please apply today.

Please follow this link for a closer look at what it’s like to work at Children’s Wisconsin: https://www.instagram.com/lifeatcw/

Children’s Wisconsin is seeking an experienced Payer Credentialing Coordinator to manage provider enrollment with insurance and managed care entities. The ideal candidate has at least five years of relevant experience and exceptional organizational skills.

Work Schedule: Full -Time, Remote

What you will do:

Coordinate and perform the provider enrollment functions and processes for all Children’s Wisconsin professional entities and our associated or contracted payers including managed care plans, insurance companies, PPO networks, employer direct contracts, and government payers. It requires accurate data entry and timely completion of all required steps for the enrollment of providers, including guiding the providers through the various processes. Communication with internal and external customers will ensure all required payer enrollment is completed successfully for claim reimbursement and payer directory purposes. The Coordinator will utilize a variety of tools, including Microsoft Office, MDStaff database software, and all payer web-based portals.

Essential Functions:

• Coordinates and performs the specific functions or processes required for the successful and timely provider enrollment required with each payer for claim reimbursement and payer directory purposes.  

• Enters and maintains provider data information on various payer web-based portals for initial and on-going payer enrollment in accordance with the department process guidelines. This includes but is not limited to Medicaid and Medicare plans

• Performs audits of provider information in all systems to ensure the data integrity prior to processing for enrollment and thereafter, including project style improvements. Problem-solves with providers to obtain missing data or documents required for enrollment with the various payers.

• Enters the provider data into the MDStaff database tool with accuracy to ensure current information is captured for payers that require electronic submission of provider rosters for enrollment. Coordinates ongoing audits of the database for accuracy of all provider data.

• Drafts and distributes roster reports from the MDStaff database that includes provider information related to additions, changes, and terminations. Records the electronic submission and receipt of submission in an organized and timely manner. Resolves all issues related to roster distribution.

• Manages ongoing provider expireable information for specific payers and assures that updated information is obtained, stored, and provided as applicable within the expected timeframe.

• Generates MDStaff standard reports and creates adhoc reports as needed for various purposes for enrollment functions and processes.  

• Continually improves and develops processes and/or systems to gain efficiencies that affect the payer enrollment of providers.

• Provides support as needed to the Payer Contracting and Revenue Cycle teams to investigate issues and resolve problems related to provider participation status, claim submission and payment.

• Verifies the ongoing accuracy of on-line and paper provider directories.

What you will need:

• Associates Degree preferred.

• Minimum of five years of Payer credentialing, managed care, health insurance, or health system experience required.

• Ability to type 30+ words per minute preferred.

• Proficient with Microsoft Office, including Outlook email with an emphasis on Excel and Word required.

• Maintains a high degree of confidentiality in dealing with sensitive provider issues and data.

• Strong customer service and interpersonal skills to work well with internal (physicians, etc.) and external customers (insurance companies, etc.)

• Strong organizational skills with the ability to prioritize and meet deadlines.

• Must be detail-oriented in order to ensure all required information/data has been received and processed to meet credentialing timelines.

• Must be able to work cohesively in a team oriented environment and able to foster good working relationships with others both with internal and external customers.

Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.

Certifications/Licenses: