Provider Enrollment Specialist

Job Description

:Provides ongoing support and coordination as a liaison between the Medical Staff, Medical Directors, and Administration. The position directs the on-going credentialing / privileging process and other administrative functions for the Medical Staff, Medical Director, Administration, and Allied Health Professionals.

Essential Functions

• Participates in enrollment progress update meetings for assigned market. Provides status information to stakeholders. Keeps detailed notes about enrollment progress in provider enrollment database and distributes information to designated department representatives and credentialing administrators.
• Completes all payer re-credentialing requests and demographic/roster requests.
• Completes out-of-State Medicaid individual and facility enrollments timely and accurately for assigned States.
• Participates in team work sessions for each market to address Epic hold and denial work queues and communicate issues and trends to leadership. Collaborates with AR to identify claim denial trends and with Coding to identify trend denials related to CPT codes and specific payer types.
• Coordinates all aspects of provider enrollment with commercial and government (Medicare and Medicaid) professional fee payer contracts for an entire market. Ensures enrollment is completed timely and accurately. Follows-up with managed care organizations and government payers to ensure timely and accurate enrollment.

Skills

• Computer literacy
• Microsoft Office
• Communication (oral and written)
• Organizational Skills
• Attention to Detail
• Accountability/ability to work independently
• Customer Service
• Knowledge of medical billing and collections
• Medical terminology

Job Essentials

1. Responsible for ensuring timely and accurate facility, medical group, and individual government enrollments for technical and professional fee claim reimbursement.

2. Coordinates all aspects of provider enrollment with Intermountain Health’s commercial and government (Medicare and Medicaid) professional fee payer contracts for an entire market. Ensures enrollment is completed timely and accurately. 3. Works in all phases of provider enrollment, re-enrollment and expirables management ensuring the timely and accurate enrollment (and recredentialing) of providers in commercial and government payers.

4. Accurate data entry of up to date expirables, practice/billing locations and other pertinent information to the payer enrollment database.

5. Participate in review, completion and/or submission of provider enrollment initial and re-enrollment applications for local and national commercial, Medicare, and Medicaid payers via payer online portals or other methods as applicable.

6. Follow up with payers via phone, website, or email requesting network participation and follow up on submitted applications.

7. Assist providers, and client personnel with completion of the application, routinely follow up with insurance carriers to monitor the status of applications and resolve issues.

8. Facilitate completion, set-up and/or re-attestations of CAQH applications.

9. Participates in enrollment progress update meetings for assigned market. Provides status information to stakeholders. Keeps detailed notes about enrollment progress in provider enrollment database and distributes information to designated department representatives and credentialing administrators.

10. Submits provider change and termination requests to all health plans in a timely manner. Informs commercial and government payers and internal Intermountain stakeholders of provider and clinic updates in assigned market.

11. Collaborates with AR to identify claim denial trends and with Coding to identify trend denials related to CPT codes and specific payer types.

12. Execute large enrollment provider/payer projects. Complete provider enrollment and related duties for organizational clinic acquisitions. Collaborates with Recruitment in the onboarding and off-boarding of providers.

Minimum Requirements

High School Diploma or Equivalent

Provider Enrollment Experience

One year experience in a healthcare revenue cycle setting.

Preferred Qualifications

One year of experience working with governments payers and/or commercial payers in a revenue service setting.

Demonstrated knowledge of working medical billing database work queues.

Physical Requirements:

Qualifications

• High School graduate or equivalent is required
• One (1) year previous work experience in healthcare
• Preferred previous work experience in a revenue cycle setting
• Preferred previous work experience with provider enrollment and/ or credentialing

Physical Requirements

• Ongoing need for employee to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs.
• Frequent interactions verbally and written with providers, colleagues and leadership
• Frequent computer use for typing, accessing needed information, etc.
• Manual dexterity of hands and fingers.

Location:

Lake Park Building

Work City:

West Valley City

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$ - $

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here.

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.