Payer Credentialing Specialist - Staff Credentialing

Summary:

Provides assistance and support to the Credentialing Coordinator with the day to day operations and functions of payer enrollment. 

Responsibilities:

• Assists in the management and successful implementation of the entire payer enrollment credentialing and re-credentialing process for all providers participating at Payer Enrollment at CHRISTUS St. Vincent. Assists with maintaining timelines for enrollment/credentialing, communicates with providers and other departments to update as needed, clarify carrier information requirements, and maintain a strict level of confidentiality for all matters pertaining to provider credentials.
• Develops effective working relationships with 3rd party payers and other outside entities involved in credentialing process.
• Tracks expiration data for all licensure, certificates, insurance, etc. for employed providers and ensures that items are current.
• Maintains current credentialing/re-credentialing status with third party payers. Provides prompt response to inquiries made from third party payers, institutions, and others requesting information regarding enrollment applications for processing. Follows up with the carriers on documentation submitted.
• Assist in the ongoing management of the Managed Care database. Responsible for the accuracy and integrity of all computerized information related to appointment, reappointment, and any necessary additional data regarding enrollment.
• Maintains provider information via Payer enrollment Spreadsheet and the provider enrollment software (MD Staff). Responsible for overseeing the migration of Payer Enrollment processes from the Payer Enrollment spreadsheet to MD Staff.
• Assists to obtain credentialing data needed for enrollment, contracting, and other related purposes. Credentialing data includes but is not limited to medical degree verification, Drug Enforcement Administration (DEA) certificate, state licenses, Board certifications, Curricula Vitae (CV), malpractice insurance, and state insurance. Monitors and ensures that all documentation is current. Ensures file confidentiality and easy retrievability.
• Responsible for overseeing the enrollment and re-enrollment/re-attestation for both the CAQH (Council for Affordable Quality Healthcare) system, and New Mexico Medicaid.
• Works closely with the enrolled providers, and clinic managers to obtain missing documentation for providers pertaining to provider enrollment. Obtains required signatures and follows up with the carriers on documentation submitted.
• Assists in the payer enrollment re-credentialing process for enrolled providers, which occurs every three years.
• Assists with the execution of malpractice insurance applications with the outside carrier.
• Prepares written reports, correspondence and technical reports of a highly confidential nature, utilizing personal computer for word processing, spreadsheet, graphic and other applications as needed.
• Assists in responding to internal and external inquiries regarding routine enrollment and contract matters, as appropriate. Interfaces regularly with internal staff, clinic managers, and billing representatives.
• Interfaces regularly and builds relationships with internal staff such as clinic managers, billing representatives, etc.
• Maintains Delegated Payer Rosters, and send out rosters in a monthly cadence, and as needed.
• Ensures Enrollment remains active for all employed providers, for both Delegated and Non-Delegated payers. Responsible for maintaining documentation for both Delegated and Non-Delegated Payers.

Requirements:

Education:

• High school diploma or equivalent required.

Experience:

• Two years secretarial or administrative experience. Experience with Microsoft Word and Excel.
• Strong English reading and writing skills
• Ability to communicate effectively utilizing strong written and verbal communication skills
• Strong organizational skills
• Ability to learn new software programs and operate general office equipment
• Excellent telephone skills, with ability to transmit and receive information accurately
• Ability to work independently with minimal supervision and in stressful situations and perform multiple tasks simultaneously

Certifications, Registrations, or Licenses:

• N/A

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time