Provider Enrollment Specialist – Candler County Hospital – Metter, GA

JOB SUMMARY:

The Enrollment Specialist is accountable for the enrollment of providers in government and managed care health plans and communicating the status to internal staff as well as the provider. The Credentialing Specialist is responsible for all aspects of payor credentialing and re-credentialing.

ESSENTIAL FUNCTIONS of this job description include but are not limited to:

• Compliance and maintaining current and accurate data for all providers in the CAQH and online systems
• Completing, submitting and follow up of all Medicare, Medicaid, CMO and commercial network participation applications and recredentialing applications including effective dates, provider ID’s, NPI, license and DEA information, quarterly CAQH attestation. Also, maintains PECOS portal and Medicaid web portal setup and user information, collaborates with multiple departments to onboard providers and disseminate provider information. Communicates with CBO and insurance representatives to resolve network participation issues. Maintains an employed physician & practice roster
• Maintains a high level of confidentiality and demonstrates professionalism with all staff members, vendors, and visitors.
• Assists with initial application credentialing during times of high volume
• Assists with reappointment and recredentialing process for physicians and AHPs
• Maintains safe, secure, and healthy work environment by following, and enforcing standards and procedures; complying with legal regulations.
• Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Performs other tasks and duties as assigned in an efficient, effective and cost-conscious manner, complying with all hospital policies, procedures, and regulations.

KNOWLEDGE, SKILLS, QUALIFICATION and EDUCATIONAL AND /OR EXPERIENCE REQUIREMENTS:

• Associate’s Degree preferred/High School or GED required
• 2+ years in credentialing, medical billing, or related role experience preferred
• Excellent organizational skills, and
• Proficiency in Microsoft Office Suite
• Strong organizational and interpersonal skills
• Ability to:
  • determine appropriate course of action in more complex situations
  • work independently, exercise creativity, be attentive to detail, and maintain a positive attitude
  • manage multiple and simultaneous responsibilities and to prioritize scheduling of work
  • maintain confidentiality of all medical, financial, and legal information
  • complete work assignments accurately and in a timely manner
  • communicate effectively, both orally and in writing/electronically
  • handle difficult situations involving patients, physicians, or others in a professional manner
• Provide excellent customer service skills and basic computer skills required
• Possesses good interpersonal skills, initiative, integrity, flexibility, adaptability, and must be a team player

PHYSICAL DEMANDS / WORKING CONDITIONS:

Sitting, standing, walking bending/twisting, kneeling/squatting, reaching, climbing and should be able to lift 25 or more pounds using proper lifting techniques. Rapidly changing and stressful environment. Ability to communicate with various levels of people. Possible exposure to communicable and infectious disease and hazardous materials. Occasional exposure to unpleasant patient or unit elements (accidents, injuries and illness). Contact with patients under a wide variety of circumstances. Subject to varying and unpredictable situations. Handles emergency or crisis situations. Subject to many interruptions. Occasional pressure due to multiple tasks and inquiries.

The information in this job description is intended to describe the general nature and level of work being performed by people assigned to this classification and requirements for the performance of this job.

They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

Candler County Hospital is an equal opportunity Employer and drug free work place