Payor Credentialing and Enrollment SpecialistEskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 333-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus including at a network of Eskenazi Health Center sites located throughout Indianapolis.
FLSA StatusNon-Exempt
Job Role SummaryThe Payor Credentialing and Enrollment Specialist is responsible for all Delegated Credentialing Functions including completion of rosters and any forms or supporting documentation required under the contracts established with the payors to support enrollment of providers, credentialing and enrollment of facilities in compliance with payor contracts. The Payor Credentialing and Enrollment Specialist is responsible for understanding payor guidelines for enrollment and delegated credentialing for all contracted plans including governmental and commercial plans pertaining to both providers and service locations. In addition, they will work with contracted payors, providers, and operational areas obtaining accurate information and timely enrollment of providers with all contracted payors/insurance plans.
Essential Functions and ResponsibilitiesPrepares and verifies applications for initial enrollment and re-enrollment for providers and service locations within established time frames and in accordance with the standards required by Medicare, Medicaid, and other contracted third-party payers.Maintains the practitioner database and internal checklists and provider files to ensure it is accurate and current in Cactus; communicates and follows up with new providers to ensure all enrollment paperwork is sent out and returned within established time frames; notifies management if a provider is not responding; generates ad hoc reports from CACTUS and other internal dashboards/monitoring tools upon request.Ensures that existing workflow is updated to include new contracts/payors as new contracts are signed with payors. This includes update of all dashboards and internal checklists and audit tools pertaining to the job.Maintains proof of licensure renewals, professional liability coverage, collaborative agreements, and other required certifications.Recommends changes to policies and processes to ensure compliance and timely completion of provider enrollments to management team.Serves as information resource to health care providers and all of Eskenazi Health regarding enrollment status and processes with various payers.Provides assistance with projects as requested by the management staff of Eskenazi Health.Creates an electronic record of all enrollment files and documents within Cactus.Participates in and performs delegated credentialing process, including updating payer policies in accordance with industry standards and guidelines for all carriers with whom there is an agreement.Provides reports pertaining to delegated credentialing for payers as requested or as required by contract.Maintains Cactus admin access to update software as needed for provider enrollment, including training on Cactus software.Job RequirementsAssociate degree in Business Administration or equivalent experience is required; Bachelor's degree or equivalent experience is preferred.Five years of job-related work experience may be accepted in lieu of degree.Four years of experience with healthcare provider enrollment and/or credentialing required.Knowledge, Skills & AbilitiesComputer skills to include database, word processing, spreadsheet, and use of internet services.Presents a professional image and cooperative attitude to multiple groups.Excellent communication skills - verbal (both face-to-face and telephone) and written.Ability to provide guidance and feedback in a positive and professional manner.Excellent organizational skills and attention to detail.Ability to prioritize and coordinate completion of a number of activities/projects simultaneously.Ability to work independently and with minimal supervision.Ability to work effectively in a team environment.Ability to complete work during high-pressure periods while maintaining flexibility and a pleasant attitude.
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