Senior Provider Enrollment Specialist, Day Shift, Managed Care (Gaithersburg)

Senior Provider Enrollment Specialist

Adventist HealthCare seeks to hire an experienced Senior Provider Enrollment Specialist for our Managed Care department who will embrace our mission to extend God's care through the ministry of physical, mental, and spiritual healing. As a Senior Provider Enrollment Specialist, you will :

• Responsible for overseeing, monitoring, and maintaining the processes involved in both initial and revalidation of payer enrollment applications. Including for AHC facility enrollment.
• Possess a thorough comprehension of payer enrollment requirements and regulations governing enrollment to ensure ongoing compliance.
• Responsible for securing timely enrollment by submitting applications ahead of deadlines and maintaining consistent follow-up with payers through completion.
• Conduct research and document enrollment processes encompassing, but not limited to, initial enrollment, revalidation, and demographic changes.
• Regularly update and manage data in the credentialing database, spreadsheets, and folders, while maintaining data integrity.
• Assures compliance with payer requirements as related to the provider enrollment and monitor activities to ensure compliance with all procedures and regulations.
• Participate in the development and implementation of payer enrollment processes and procedures and provide input regarding process improvement.
• Serve as primary contact for payer inquires and issue resolution, specifically related to enrollment and credentialing matters. Including obtaining provider numbers for billing.
• Performs other duties as assigned.
• Submitting information to IT to load provider numbers and effective dates to the billing systems.
• Update CIN members' information for the portal.
• Collaborate with the Medical Staff Office to address questions, provide updates, and participate in meetings related to provider onboarding, ensuring alignment with organizational policies and payer requirements in accordance with NCQA standards for delegated credentialing.
• Actively engage with payers on issues related to enrollment or claims denied for credentialing. Generate and prepare monthly provider reports of new, updated, and terminated providers for delegated payers.
• Collaborate with Provider Recruitment on new service lines and provider onboarding.
• Track agreement participation for AHC's CIN network and oversee delegated credentialing rosters and audits.
• Maintain and apply for National Provider Identification (NPI) numbers for entities.

Qualifications include :

Work Schedule : Day Shift

Pay Range : $71,932.12 - $107,889.60

If the salary range is listed as $0 or if the position is Per Diem (with a fixed rate), salary discussions will take place during the screening process.

Under the Fair Labor Standards Act (FLSA), this position is classified as : United States of America (Exempt)

At Adventist HealthCare our job is to care for you. We do this by offering :

As a faith-based organization, with over a century of caring for the communities in the Maryland area, Adventist HealthCare has earned a reputation for high-quality, compassionate care. Adventist HealthCare was the first and is the largest healthcare provider in Montgomery County. If you want to make a difference in someone's life every day, consider a position with a team of professionals who are doing just that, making a difference.

Join the Adventist HealthCare team today, apply now to be considered!

Adventist HealthCare strongly recommends all applicants to be fully vaccinated for COVID-19 before commencing employment. Applicants may be required to furnish proof of vaccination.

Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine and drug use. While some jurisdictions, including Maryland, permit the use of marijuana for medical purposes, marijuana continues to be classified as an illegal drug under the federal Controlled Substances Act. As a result, medical marijuana use will not be accepted as a valid explanation for a positive drug test result. Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine) and marijuana. Those testing positive are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing.

Adventist HealthCare is an Equal Opportunity / Affirmative Action Employer. We are committed to attracting, engaging, and developing the best people to cultivate our mission-centric culture. Our goal is to have a welcoming, equitable, and safe place to work and grow for all employees, no matter their background. AHC does not discriminate in employment opportunities or practices on the basis of race, ethnicity, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, pregnancy and related medical conditions, protected veteran status, or any other characteristic protected by law. Adventist HealthCare will make reasonable accommodations for applicants with disabilities, in accordance with applicable law. Adventist HealthCare is a religious organization as defined under applicable law; however, it will endeavor to provide reasonable accommodations for applicants' religious beliefs. Applicants who wish to request accommodations for disabilities or religious belief should contact the Support Center HR Office.