Provider Enrollment Coordinator

Worker Type: Regular
Location: Remote with some time onsite at SSM Health Corporate Office (St. Louis, MO) for training and meetings.
Candidates to reside in the St. Louis, MO region

About the role

Responsible for proactive enrollment of physicians and other health care practitioners for participation in government programs and with contracting commercial payers.

Responsibilities

• Identify denial trends and work with team to facilitate root cause analysis and continuous process improvement.
• Prepare and submit government credentialing applications and supporting documentation for enrolling and re-enrolling individual physicians and other healthcare practitioners with Medicare, Medicaid, and other government payers.
• Prepare and submit government payer re-credentialing applications as required by Medicare, Medicaid, or other government payers.
• Coordinate with regional managed care staff to ensure physicians and other health care providers are enrolled timely with contracted commercial payers.
• Work claim edit work queues and add provider identification numbers to Epic to ensure claims are released for payment.
• Follow up on claims that are rejected or denied due to provider enrollment issues.
• Coordinate with medical group leaders and clinic staff on all enrollment matters, including receiving timely notification of new providers, obtaining necessary enrollment documents timely, and providing feedback relating to provider issues that impede the enrollment process.
• Perform other duties as assigned.

Requirements

• Provider enrollment and credentialing experience strongly preferred.
• Experience with ECHO or Credential Stream software preferred.
• High School diploma/GED or 10 years of work experience.
• One year of experience.

Physical Requirements

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching, and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication.
• Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting, and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare climbing.

Schedule

• Full Time, Monday-Friday, Days
• Scheduled Weekly Hours: 40

Benefits

• Paid Parental Leave: one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
• Flexible Payment Options: voluntary benefit through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay before payday (fees may apply).
• Upfront Tuition Coverage: upfront tuition coverage through FlexPath Funded for eligible team members.