Position Summary

Under general supervision, the Insurance Enrollment Specialist is responsible for preparing, submitting, and maintaining enrollment, credentialing and recredentialing documentation for physicians and other healthcare providers with insurance payers to support the financial stability of the organization.

Position Responsibilities

Unit Specific Position Responsibilities

Prepares and tracks documents necessary to enroll physicians and non-physician providers with insurance carriers.

Performs data entry and maintains provider information in online credentialing databases and systems (CAQH, PECOS, and NPPES).

Manages provider initial and re-credentialing applications.

Completes and submits credentialing applications and supporting documentation to all requested payers.

Audits applications for accuracy and completeness.

Monitors application progress and follows up with payers as needed until confirmation of “in network” status has been received.

Maintains deletions, additions, and changes to the Physician Enrollment file for all pertinent information including review of payer membership.

Review and update health plan directories/rosters, agencies, and other appropriate entities for current and accurate provider information.

Monitors and corrects enrollment issues and errors.

Follows facility and insurance payer guidelines for preparing documents in a consistent and accurate manner.

Handles telephone communications and written correspondence with providers and fiscal intermediaries in an efficient and effective manner that facilitates the Provider Enrollment process.

Maintains updated information per insurance carrier requirements through contact with the carriers and by reviewing bulletins, and other materials sent to the facility and providers.

Understands and complies with department and organization policies and insurance carrier guidelines.

Works collaboratively with Patient Financial Services Manager, Business Office, Medical Staff Office, Providers, and the CEO to coordinate the application process.

Displays responsiveness and flexibility to adapt to changes in work environment and modify approaches or methods to best fit the situation.

Performs other duties, responsibilities, and special projects as assigned.

Qualifications, Knowledge Experience

Required Qualifications (Including any licensure, certification, education):

Associates degree in business, healthcare related field preferred or equivalent experience.

Organizational Requirements:

Maintain stroke education per regulatory requirements.

Preferred Qualifications:

Experience in credentialing, privileging, or other medical experience relevant to insurance carrier credentialing, re-credentialing and follow up preferred

Required Knowledge, Skills Experience:

Excellent written and verbal communication skills, customer service skills, including professional telephone skills.

Good organizational skills and the ability to pay attention to detail.

Ability to analyze and interpret information to make decisions within scope of job functions with minimal supervision.

Ability to read and interpret basic to moderately complex documents such as operating and maintenance instructions, procedure manuals, and government/healthcare guidelines.

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

Preferred Knowledge, Skills Experience:

System experience in CAQH, PECOS, NPPES, Cactus