Job Responsibilities:
- Acts as a liaison between insurance agencies on behalf of Marshall Health Network's providers, groups, locations and hospitals.
- Holds responsibility for accurate, timely and prompt initial enrollment and re-credentialing of Marshall Health Network providers, groups, locations and hospitals.
- Researches information as required for enrollment and share with team members
- Ensures data integrity including but not limited to CredentialStream, CAQH, PECOS, NPPES, I&A System, OH Medicaid, KY Medicaid and Availity.
- Maintains current, electronic, detailed files for provider, group, location and hospital
- Collects required documents from providers, department administrators, MD Staff and primary source verification websites.
- Assists in capturing key performance indicators as requested/required on steps of provider reimbursement enrollment by annotating dates including but not limited to: documents/information requests, receipts of requested documents/information, receipt of signed documents, submission of application, completion of enrollment by carrier in addition to notification of onboarding of provider and provider anticipated start date
- Works with physicians and Department Administrators to obtain signatures in an expedited fashion
- Works with Business Office to resolve claim issues as it pertains to provider reimbursement enrollment.
- Works on a common goal to streamline provider reimbursement enrollment
- Demonstrates competence in day-to-day schedule of duties by completing tasks on time.
- Consults with and offers direction to team members regarding provider reimbursement enrollment
- Enhances professional growth through participation in educational programs to stay current with applicable accreditation, enrollment and re-credentialing standards per federal and/or state guidelines.
- Provides reports as requested and required to ensure departments are current with provider enrollment status, licensure expirations, etc.
- Captures key performance indicators as requested/required
- Performs other duties as assigned and/or requested.
EDUCATION: Bachelor's degree in business or health care administration, or related experience or certification regarding provider enrollment.EXPERIENCE: Three to five years' experience in health care setting, with provider enrollment, physician licensure experience preferred. Experience in billing and accounts receivable helpful.Internal applicants must call HR at ext. 11653 to determine eligibility before applying.