As part of the Shriners Children's (SC) Department of Corporate Credentialing this position is responsible for coordinating, monitoring and maintaining provider enrollment and re-enrollment for physician/advanced practice professional providers participation in all third party and government insurance which SC sites participation with. Continuously exemplifies the mission, vision, values and customer service philosophy of SC in job performance and in service to other persons outside of and throughout the organization.
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Manages the completion and submission of provider applications for enrollment in all commercial insurance and Medicaid Managed Care plans for multiple locations in the SC system. Tracks and maintains enrollments through timely re-validations. Follows strict guidelines to protect providers’ information, and maintain confidentiality.
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Works closely with the insurance enrollment departments to discern specific enrollment requirements including pre-requisites, forms, documentation, and timelines. Establishes relationships at the health plans necessary to promote swift enrollment turnaround time. Performs follow-up with insurance payers via phone, email, fax or website to resolve provider enrollment issues. Negotiates to overcome roadblocks. Collaborates with Health Plan Liaisons to address unresponsive health plans or streamline enrollment processes.
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Maintains accurate records of enrollment activities in OnBase, including but not limited to, maintaining enrollment data, documenting activities through notes, tracking progress on enrollment worksheets, uploading enrollment related documentation and communications, for access by all team members, and to ensure business continuance.
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Establishes providers’ CAQH (Council for Affordable Quality Healthcare) profiles. Maintains profiles up to date, uploading documents as required, and re-attesting profiles every 120 days. Maintains MCC (Minnesota Credentialing Collaborative) profiles for providers at our Minnesota location, if applicable.
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Coordinates with hospital staff to obtain provider signatures and additional data necessary for enrollments. Establishes and maintains positive relationships with staff, both at the hospitals and Headquarters.
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Prioritize workload, so as to promote hospital revenue goals, and to support Network Management contracting efforts as needed.
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Point of contact for hospitals and HQ personnel for questions relating to enrollment with Commercial Insurance and Medicaid Managed Care plans. Addresses inquiries in a timely manner, includes appropriate personnel, and escalates issues as appropriate.
This is not an all-inclusive list of this job’s responsibilities. The incumbent may be required to perform other related duties and participate in special projects as assigned.
Minimum:
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1 year of credentialing or provider enrollment experience
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Expertise with Adobe Pro and MS Office
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High School Diploma/GED
Preferred:
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Medicare, State Medicaid, and third party practitioner enrollment experience
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CAQH, MD-Staff credentialing database, or other credentialing/enrollment data bases
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Associate's degree
