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Provider Enrollment Coordinator

Company: Driscoll Children's Hospital
Location: Corpus Christi
Posted on: January 12, 2022

Job Description:

The Provider Enrollment Coordinator is responsible for all aspects of credentialing, re-credentialing process for hospital affiliated providers. Responsible for ensuring entities are credentialed, appointed, and privileged with health plans and hospitals. Maintains up to date data for each provider in credentialing databases and online systems; ensures timely renewal of license and certifications. Understands the insurance plan requirements for credentialing all types of providers. Collaboratively work with a team of individuals tasked with credentialing applications and will serve as the lead for information on enrollment status.Essential Duties and Responsibilites:

  • Maintain utmost level of confidentiality at all times
  • Adhere to hospital policies and procedures.
  • Demonstrate business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
  • Compiles and maintains current and accurate data for all providers.
  • Maintains copies of curent state license, DEA certificates, board certifications and any other required credentialing documents for all providers.
  • Sets up and maintains provider information in online (internally and external insurance companies) payer credentialing databases and systems.
  • Tracks licenses and certification expirations for all providers to ensure timely renewals.
  • Provides support to other departments regarding provider effective dates / provider numbers and keeps appropriate IHA personnel informed as to the status of credentialing of new providers.
  • Supervises and oversees the preparation, submission and follow-up of credentialing and enrollment applications by clinical staff and ensures that supporting documentation is collected and provided to ploans/hospitals as needed in a timely manner.
  • Establishes and maintains provider files to include necessary documentation and understands the plan requirements for credentialing a provider with all of insurance carriers we currently participate with for all types of providers.
  • Knowledge of Medicare and Medicaid provider enrollment rules and guidelines.
  • Lead contact for commercial contracting and network representatives.
  • Follows up on the status of applications and provider licenses and facilitates the renewal process; tracks the progress on all pending applications and works to resolve issues as they arise.
  • Oversees provider online database, tracks licensure expirations and ensures that updated licensures are received.
  • Manage documentation and proper communication workflows for all new provider credentialing
  • Provides education and resources to practice managers and clinic administration on an as needed basis.
  • Brings areas of concern and recommendations to Clinic Administrator and Revenue Cycle Director.
  • Supports special project work as needed.Education and/or Experience:
    • Associate's Degree. Candidates with comparable combination of education and related experience may be considered.
    • 3-5 years' previous credentialing/enrollment or proivder relations experience in related area
    • Substantial knowledge of payer credentialing
    • Knowledge of payer processes, local, state, and federal requirements
    • High level of skills in operating a standard desktop and Windows-based computer system, including but not limited to Microsoft Word, Excel, PowerPoint, Outlook, database applications, presentation software, Intranet and computer navigation
    • Excellent organizational, analytical, time management and attention-to-detail skills for the execution of multiple assignments
    • Ability to work collaboratively in a team-oriented environment; courteous, professional, and friendly demeanor
    • Ability to work independently with minimal supervision, plan, organize, prioritize assignments and responsibilities and time constraints in a fast-paced environment and adapt to them as they change frequently.
    • Prior experience with EPIC is a plus
    • Strong oral and written communication skills
    • Ability to cross-train in other areas of the department in order to achieve smooth flow of all operations
    • Ability to multi-task and work on multiple projects simultaneously.
      Ind123Classification:Full-time Regular (72+ hrs/pp)Work Schedule:Days

Keywords: Driscoll Children's Hospital, Corpus Christi , Provider Enrollment Coordinator, Other , Corpus Christi, Texas

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