Provider Enrollment Coordinator - Summit Medical Group

Summit Medical Group is recruiting for a Provider Enrollment Coordinator. This is a full time opportunity. This position ensures that paperwork, documentation, and credentials of Summit physicians are processed and forwarded as required by appropriate agencies and healthcare insurance companies; proactively notifies supervisor of any significant issues.

Examples of Duties (List does not include all duties assigned)

• Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications.


• Maintain internal software to ensure all information is accurate and logins are available.


• Update each provider’s CAQH database file timely according to the schedule published by CMS.


• Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance.


• Complete revalidation requests issued by government payers.


• Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid.


• Complete re-credentialing applications for commercial payers.


• Provide credentialing and re-credentialing documents to hospitals for those providers with hospital privileges.


• As part of the AR Department will work closely to AR Billing Managers to identify and resolve any denials or authorization issues related to provider payer
  enrollment.


• Maintain accurate provider profiles in CAQH, PECOS, NPPES and CMS databases.


• Provide support to physicians, physician office staff, health plan contacts and company departments, as necessary.


• Provide consistent and timely follow-up on all outstanding payer enrollment/recredentialing files.


• Process provider demographic changes ensuring appropriate documentation has been submitted with the changes, update credentialing database and notify health plans of changes.


• Process provider network terminations, specialty/category changes, leave of absence requests.


• Cross train within department to support payer enrollment operations (providing back-up support for files, vacation, etc.)


• Maintains strictest confidentiality both internally and externally.


• Adheres to expectations of the established corporate compliance plan.


• Actively participates in site-level Quality Improvement Activities. Each employee will contribute to the continual evaluation site performance as well as the implementation and measurement of improvement activities that increase the quality of care provided to patients.


• Performs related work as assigned.

Education

High School Diploma required, vocational or college credits preferred.

Experience

2 years credentialing/payer enrollment experience preferred
2 years’ experience in a medical practice business office role required