Provider Enrollment Coordinator II

Job Duties

• Provides completed enrollment documents to the providers after receiving notification from the Credentialing department, Clinical Operations, Coordinators, or any other means.
• Maintains a complete understanding of the items required for enrollment for each participating insurance plan.
• Prepares and submits government credentialing applications and supporting documentation for the purpose of 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
• Stay abreast of upcoming changes to forms; process, to ensure enrollments are completed correctly and in a timely manner.
• Provides day-to-day support and advice regarding enrollment.
• Provides feedback to other staff departments with regards to issues relating to enrollments.
• Responsible for identifying denial trends and working with teams to facilitate root cause analysis and continuous process improvement.
• Maintains an understanding of the third-party payor requirements.
• Covers coordination of providing monthly-managed care files to all the Third Party Payor in which Geisinger has a delegated credentialing agreement.
• Covers coordination with regional managed care staff to ensure physicians and facilities and other health care providers are enrolled timely with contracted commercial payers.
• Provides follow-up with each payor on any enrollment issues that are a result of the monthly downloads.
• Works claim edit work queues and adds provider identification numbers to Epic to ensure claims are released for payment
• The coordinator is a liaison that will be responsible to attend meetings with Operations, Rev Cycle, Legal, Quality Performance and Third-party payors to assist with opening new locations, onboarding of new services in the organization.
• Provides technical resources to the department regarding all billing systems responsibilities, such as claim form logic, referring provider dictionary, provider dictionary, billing area dictionary, location, specialty etc.
• Responsible for maintenance of all providers, referring physicians, billing areas, locations, and hospitals within the billing system(s).
• Ensures the National Practitioner Identification numbers are applied for on behalf of Geisinger and maintained with any needed updates
• Ensures the systems are updated appropriately.
• Updates Medicare, Medicaid and Third Party Payor and any changes.
• Updates and maintains CAQH practitioner accounts to ensure proper payer enrollment, including malpractice certificate updates
• Completes Enrollment for Third Party Payer Hospital Contract and Out of State Medical Assistance.
• Organizes and maintains enrollment files and information following confidentiality guidelines, performs varied clerical support functions.
• Internally audits and maintains physician files in accordance with established principles of legal documentation and confidentiality.

About the Role

Responsible for the enrollment process for all Geisinger Providers and third-party payers. Responsible for the facility enrollment for all Geisinger owned entities. Ensures appropriate provider and facility enrollment procedures and policies are in order to accurately and timely enroll providers and facilities with all payers while ensuring compliance with contractual, state, and federal regulations. Ensures proactive review and process change based on proposed/enacted regulatory changes.

Requirements

Minimum of 3 years-Related work experience

Qualifications

High School Diploma or Equivalent (GED)

Skills

Teamwork; Communication; HR Policies, Standards And Procedures; Office Politics And Confidentiality; Computer Literacy

Benefits

We offer healthcare benefits for full time and part time positions from day one, including vision, dental and prescription coverage.

Pay

N/A

Schedule

N/A

Benefits

A place where you can lead a healthy lifestyle and follow your dreams.