Provider Enrollment Coordinator (Enrollment Coordinator)

The Enrollment Coordinator is responsible for enrolling OHSU Practice Plan practitioners, OHSU affiliated practitioners, OHSU facilities, and OHSU Partners’ facilities with government and insurance carriers; and is responsible to initiate and maintain active billing status in accordance with organizational policies and procedures, regulatory requirements and contracts for governmental and commercial payers, and Medical Staff Bylaws.

Enrollment Process

• Utilize Health Information Systems to analyze and investigate practitioner information, and distribute provider credentialing and enrollment packets in coordination with OHSU Medical Affairs Program, meeting established policies and procedures.
• Prepare and distribute practitioner and facility data, complying with the requirements outlined by state government, federal government, and commercial carriers.
• Perform data entry of sensitive provider information in federal and state provider enrollment systems.
• This process requires knowledge of legal, federal, state, and OHSU requirements; the National Plan and Provider Enumeration System (NPPES); the Medicaid Management Information System (MMIS); licensing boards; MSOW; the Oregon Practitioner Credentialing Application (OPCA); the Provider Enrollment Chain and Ownership System (PECOS); the CMS Identity and Access Management System; and, Washington’s ProviderOne.
• Collaborate with OHSU Medical Affairs Program, OHSU departments and OHSU Partners to achieve accurate credentialing, timely enrollment, and compliant billing status. Troubleshoot problem claims in EPIC work queues.
• Maintain positive relations with insurance carriers to assist with timely reimbursement, problem solving, and plan participation.
• Perform timely annual enrollment and termination of residents and fellows.

File Maintenance

• Collect and maintain appropriate provider documentation and licensure, perform manual enrollment processes, and facilitate practitioner payer re-credentialing and revalidations. Update and maintain practitioner and facility database as a central resource for OHSU, OHSU Health Plan and OHSU partners, including department and billing personnel.
• Document, maintain and understand regulatory requirements for governmental and commercial payers.

Audits and Special Projects

• Develop and update necessary workflows and documentation relevant to provider enrollment to improve effectiveness of department operations.
• Provide ad hoc reporting based on need or request. Participate in special claims correction projects related to enrollment.
• Promote and implement LEAN processes.
• Perform other duties as assigned.

• High School Diploma or equivalent required, AND 2 years in health care, medical billing and/or insurance environment. Experience with provider enrollment or insurance credentialing, including knowledge of governmental and commercial insurance and HIPAA regulations, and understanding of managed care contract policies in a health care or insurance carrier setting required; OR 

• Associate's degree and 1 years’ experience health care and/or health insurance; OR 

• A combination of education and experience.

• Demonstrated software database experience (for efficient generation of letters and other correspondence, activity tracking and report production).

• Demonstrated ability to work with a diverse team and customer base, using excellent communication skills, listening, verbal, and written.

• Strong organizational skills, accurate data entry, and the ability to multi-task. 

• Proficiency with standard office equipment and software such as Microsoft Office.

• Knowledge of health care information systems.

• Familiarity with legal, state, and health care insurance guidelines, assuring compliance with regulatory agencies.

Benefits 

• Healthcare for full-time employees covered 100% and 88% for dependents.
• $50K of term life insurance provided at no cost to the employee.
• Two separate above market pension plans to choose from.
• Vacation - up to 200 hours per year dependent on length of service.
• Sick Leave - up to 96 hours per year.
• 9 paid holidays per year.
• Substantial Tri-Met and C-Tran discounts.
• Employee Assistance Program.
• Childcare service discounts.
• Tuition reimbursement.
• Employee discounts to local and national businesses.