ESSENTIAL FUNCTIONS
Please make sure you read the following details carefully before making any applications.
Enrolls assigned facilities with government payers timely and accurately.Follows Medicare PECOS Provider Enrollment Policy.Follows Maryland Medicaid ePrep Enrollment Policy and other states as applicable.Ensures NPPES website and provider enrollment portal records are updated with providers' most current billing-related information timely and accurately.Applies for new NPI numbers as required.Obtains and maintains information necessary for facility enrollments from A/R Managers, JH tax office, board secretary, board members, JH insurance office, etc.Obtains and maintains copies of current facility & professional licenses necessary to update enrollments from point persons at JHCH.Completes revalidation enrollments as required and assures accurate hours of operation, product offerings, contact information, etc.Coordinates updates with consideration of other changes needed or revalidation needed in the near future.Adds product offerings as necessary to enrollments and coordinates with the Quality Department to notify the accrediting body.Resolves disputes, discrepancies, and other provider enrollment-related problems, as necessary.Completes license applications as required and in a timely manner for assigned entities and works with LicenseLogix & licensing liaisons at JHCH to assure licensing is kept current.Completes JHCH Managed Care payor credentialing documentation as required by each entity to remain contracted.Completes network provider amendments, cover letters, and documentation tracking logs to support provider contracting changes.Packages and coordinates certified mail and email communications to network providers, and managed care payers, upon contracting and/or policy changes.Completes network provider credentialing, responds to network provider requests to join the network, and works with JHCH payor contracting liaison to ensure network adequacy.Works with JHCH payor contracting liaison and Connections Financial Ops Program Manager to maintain relevant network provider contact lists via list serve to ensure providers receive accurate and timely notifications of network changes.Responds to credentialing application questions and/or assigns to responsible party to complete within established guidelines.Assembles the credentialing packet, completes data entry, and attaches all required documentation to the application for circulation.Circulates the credentialing packet to all JHHCBS stakeholders for review and obtains answers, resources, edits, and approval as needed.Updates (as necessary) and validates all application question sets, ensuring a response and appropriate documents are attached.Submits the completed credentialing package and memo to OSA Contracting.Education:
- Bachelor's degree required.
- Demonstrated experience in provider enrollment with Medicare and/or Medicaid required.
- Equivalency allowed in place of education or experience.
Work Experience: Minimum two (2) years of medical office and/or billing experience required.
Johns Hopkins Medicine prioritizes the health and well-being of every employee. Come be healthy at Hopkins!
Diversity and Inclusion are Johns Hopkins Medicine Core Values. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
#J-18808-Ljbffr