Provider Enrollment & Credentialing Specialist (2734)

Job DetailsJob Location: USHV - Corporate Main - Franklin, TN 37067Position Type: Full TimeEducation Level: High School Diploma/GEDTravel Percentage: NoneJob Shift: DayJob Category: Other PositionsUS Heart and Vascular is in need of a Remote Provider Enrollment & Credentialing Specialist to join our team Position Summary Be the first point of contact to staff; resolve enrollment & credentialing issues by answering questions, making recommendations for resolution and escalation, checking enrollment status, verifying payer enrollment requirements and system implementation, appropriately follow-up on Provider Issue Forms; facilitates group and individual enrollment with commercial and government payers. Responsibilities: Resolves issues and concerns by correctly answering questions from staff and providing appropriate follow-up on issues, escalating to Team Manager, when appropriate Provides the team with coaching, training, and auditing on assigned tasks. Partner with Team Manager to evaluate team’s performance to improve overall production and facilitate continuous improvement. Assists Team Manager in monitoring inventory and production and facilitates the escalation process as needed. Become proficient in discussions with payors to facilitate closure of any identified issues. Research and review individual Provider Issue Forms for appropriate follow-up and resolution. Maintain Matrices - payer enrollment, matrix, SOPs, new site sheets, email templates, welcome letters, etc. Create and distribute reports containing provider credentialing and enrollment data for various departments within the organization. Research new state enrollment requirements for group and individual provider enrollment. Assists Contract Implementation staff with accurately documenting enrollment and billing requirements for payer contracts. Maintain and complete new entries in Veritystream. Facilitate completion and submission of payer enrollment applications for government and commercial payers. Monitor application status process to identify emerging issues and communicate them to Team Manager. Monitor enrollment status for groups and individuals. Monitor license and credential expiration dates and advise staff members of required “renew” by dates. Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases. Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications. Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance Complete revalidation requests issued by government payers. Credential new providers and re-credential current providers with hospitals at which they hold staff privileges. Work closely with the Director of Revenue Cycle and billing staff to identify and resolve any denials or authorization issues related to enrollment & credentialing. Performs and assists with other department duties as required. Knowledge, Skills and Abilities Required: Meticulous follow-through of delegated tasks, including follow-up with staff to ensure completion, quality, and meeting deadlines. Ability to exhibit leadership by demonstrating commitment to team development, adapting to change in a positive manner, and supporting alignment with organizational goals including continuous improvement efforts. Ability to pay close attention to detail and produce extremely accurate work. Strong analytical and problem-solving skills. Ability to organize and prioritize job tasks and requirements. Excellent organizational skills with the ability to prioritize assigned duties in an efficient amount of time. Ability to effectively perform in a multi-task work environment. Strong communication and interpersonal skills. Ability to effectively use oral and written communication skills with clinicians, external agencies and management in a courteous and professional manner. Must have knowledge of correct English, proper grammar and spelling. Knowledge and skills in using personal computers (Windows) with a strong emphasis on Microsoft Office Programs- Outlook, Word, Excel and Adobe Acrobat Education & Experience: High school diploma or equivalent Two (2) years office experience or college course work preferred. Knowledge of health plan billing and enrollment preferred. PECOS and CAQH experience preferred. Veritystream experience a plus.

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