Job Title: Provider Enrollment Coordinator
Department: Provider Enrollment
Reports To: Registration/Verification & Coding Supervisor
FLSA Status: Nonexempt
SUMMARY
The Provider Enrollment Coordinator is responsible for preparing and submitting credentialing applications and supporting documentation for the purpose of enrolling individual physicans and physican groups with payers. The position is responsible for the set up of PRC clients for electronic claim submission, ERA, and EFT. The PE Coordinator follows up on the status of applications for physicians and payers, tracking progress on all pending and completed work.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Successfully implements the entire enrollment and credentialing process for clients who request provider enrollment services. Coordinator must maintain timelines on enrollment/credentialing schedules, communicate 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.
- Reviews new client packet information received from Client Relations to determine the enrollment issues that need to be addressed.
- Coordinates credentialing data needed for enrollment, contracting, and other related purposes. Credentialing data includes but is not limited to the Medical degree, Drug Enforcement Administration (DEA) number, state license number, Board certifications, CV, malpractice insurance, and state insurance form. This information is typically obtained from the physicians’ office by the assigned Client Relations Representative.
- Works closely with client’s Office Managers and PRC Client Relations Representatives to obtain missing documentation for providers pertaining to provider enrollment. Obtains required client signatures and follows up with the carriers on documentation submitted.
- Maintains provider information via spreadsheets and provider enrollment software including demographics for all providers. The status of provider enrollment (PE) applications is tracked in the PE spreadsheet.
- Responds to internal and external inquiries on routine enrollment and contract matters, as appropriate. Interfaces regularly with internal staff in A/R, Registration and Client Relations
- Maintains provider credentialing files electronically via provider enrollment software, shared computer files, and CAQH (Council for Affordable Quality Healthcare).
- Prepares weekly internal DR report (Doctors without numbers Report) the first day of every week for specific clients and makes available to all Client Relations Representatives. Guides staff to any priority issues.
- Prepares monthly (for teleradiology practices) and requested reports as needed for clients and PRC management.
- Completes, submits, and tracks Clearinghouse applications for Claim submission (EDI) and Electronic Remittance Advice (ERA).
- Completes EFT authorization documents to enable payment between client and carrier.
- Releases claims held due to pending enrollment completions.
- Monitors and advises clients on license expirations.
- Oversees provider enrollment software upgrades and any on-going maintenance.
- Updates all PLIID (Physician, Location, Insurance ID) entries i.e. provider and ptan numbers once the PE process is completed.
- Other duties as assigned.
QUALIFICATIONS
REQUIRED
- Ability to work with details, research, and analyze documents.
- Follow up and track status of all applications.
- Ability to work independently, set priorities and meet deadlines.
- Communicates effectively with all departments, Client staff and Insurance contacts.
- Proficiency in Microsoft Office, particularly in Excel.
- Customer focus
PREFERRED
- Understands database utility.
- Three years working with Insurance.
- Knowledge of medical insurance carrier policies and procedures and State and Federal rules and regulations.
- Medicare, Medicaid, and Commercial Payer Provider Enrollment knowledge is preferred.