GENERAL SUMMARY:

　　Under minimal supervision, the Provider Enrollment Specialist is responsible for enrolling all billing providers with all contracted payers. Completes the Delegated Credentialing Roster accurately and timely, tracks and follows up with payer, investigates enrollment issues, and acts as a liaison for physicians, support staff & provider representatives regarding provider enrollment issues. Helps with reporting of credentialing activity to help communicate current status and age of receivables.

　　Remains current with appropriate internal and external requirements for performing the duties with highest level of quality and compliance. Works closely with teams from Revenue, Recruitment, Central Enrollment, and the Physician Hospital Organization (PHO).

　　PRINCIPAL DUTIES AND RESPONSIBILITIES:

　　Meets and confers with third party financial personnel regarding billing issues as they relate to the Provider Plan Enrollment systems. Coordinates provider files which is an integral player in provider billing and reimbursement. May be the hospital representative at external meetings which involve HFH management or employer groups.

　　Ensures compliance with all third parties for the registration of staff physicians. Responsible for the review and submission of all provider enrollment documents to Medicaid, Blue Cross Blue Shield, Medicare and other third party payers for all contracted physicians on staff. Determines appropriate specialty assignment for maximum reimbursement and accurately maintains professional and hospital physician master files. Fields incoming calls for information from numerous external and internal sites regarding provider enrollment issues.

　　Initiates communication with Patient Financial Services staff in order to monitor and resolve third party billing and compliance issues. Identifies system problems and implements corrective action, which is an integral part of insuring appropriate cash flow.

　　Act as liaison and support staff for the Council for Affordable Quality Healthcare (CAQH) initiative. Working with Administrators, Providers and Office Staff to ensure compliance with CAQH requirements and mandates by third party groups Performs special projects while taking an active role as a departmental liaison in the implementation of policies and procedures that affect Patient Financial Services and external clients.

　　Monitors rejections to determine if any profiles or master files can be updated to expedite payments and enhance either reimbursement levels or the automation process of A/R claims.

　　Analyzes and resolves user problems associated with system use from all insurance receivables to help resolve internal and external billing issues.

　　Ability to work in all phases of provider enrollment, ensuring the timely and accurate enrollment of providers with various payers and government agencies.

　　Knowledge of provider enrollment/contracting & credentialing policies and procedures.

　　Call providers to disseminate time-sensitive information.

　　Research provider issues related to enrollment with payers, Medicaid, Medicare, etc.

　　Track, monitor and follow-up with providers to ensure timely submission of CAQH attestation every 120 days.

　　Update credentialing database with new provider changes in CAQH.

　　Monitor submitted provider enrollment applications to ensure provider information is received within payers’ standards. Follow-up with payers on issues or questions related to enrollment submissions.

　　Work with payers, providers and PFS to resolve payers’ questions and issues.

　　Performs other duties as assigned

　　EDUCATION/EXPERIENCE REQUIRED:

　　· Bachelor's Degree preferred or equivalent combination of education and experience (8 years) in Computer Science, Business, Healthcare or other related area.

　　· Minimum 3 – 4 years of provider enrollment, contracting and/or credentialing experience within a healthcare setting, preferred hospital or managed care environment.

　　· Billing or reimbursement experience desired.

　　· Interact with providers and/staff to provide appropriate and timely response to inquiries and concerns regarding provider enrollment.

　　· Proficiency in Microsoft Office. Knowledge of Morrissey credentialing software or an electronic credentialing system is preferred but not required.

　　· Related technical experience, or business experience in area of application, is desirable.

　　Must meet or exceed core customer service responsibilities, standards and behaviors as outlined in the HFHS’ Customer Service Policy and summarized below:

　　Ÿ Communication Ÿ Ownership

　　Ÿ Understanding Ÿ Motivation

　　Ÿ Sensitivity Ÿ Excellence

　　Ÿ Teamwork Ÿ Respect

　　Must practice the customer skills as provided through on-going training and in-services. Must possess the following personal qualities:

　　Ÿ Be self-directed

　　Ÿ Be flexible and committed to the team concept

　　Ÿ Demonstrate teamwork, initiative and willingness to learn

　　Ÿ Be open to new learning experiences

　　Ÿ Accepts and respects diversity without judgment

　　Ÿ Demonstrates customer service values

　　Additional Information

　　Organization: Henry Ford Allegiance Hospital

　　Additional Details

　　This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.

　　Overview

　　Under the leadership of President and CEO Robert G. Riney, Henry Ford Health is a $6 billion integrated health system comprised of six hospitals, a health plan, and 250+ sites including medical centers, walk-in and urgent care clinics, pharmacy, eye care facilities and other healthcare retail. Established in 1915 by auto industry pioneer Henry Ford, the health system now has 32,000 employees and remains home to the 1,900-member Henry Ford Medical Group, one of the nation’s oldest physician groups. An additional 2,200 physicians are also affiliated with the health system through the Henry Ford Physician Network. Henry Ford is also one of the region’s major academic medical centers, receiving between $90-$100 million in annual research funding and remaining Michigan’s fourth largest NIH-funded institution. Also an active participant in medical education and training, the health system has trained nearly 40% of physicians currently practicing in the state and also provides education and training for other health professionals including nurses, pharmacists, radiology and respiratory technicians. visitHenryFord.com.Benefits

　　Whether it's offering a new medical option, helping you make healthier lifestyle choices or making the employee enrollment selection experience easier, it's all about choice. Henry Ford Health has a new approach for its employee benefits program - My Choice Rewards. My Choice Rewards is a program as diverse as the people it serves. There are dozens of options for all of our employees including compensation, benefits, work/life balance and learning - options that enhance your career and add value to your personal life. As an employee you are provided access to Retirement Programs, an Employee Assistance Program (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness, and a whole host of other benefits and services. Employee's classified as contingent status are not eligible for benefits.Equal Employment Opportunity/Affirmative Action Employer

　　Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.