Payer Enrollment Coordinator - Catholic Health

Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island.

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time.

We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace!

The Payer Enrollment Coordinator works with CH Physician Partners' payer partners to ensure timely and accurate physician contracting. This position is responsible for coordinating the transition of physician payer enrollment to the IPA.  The position will interact with Business Development, Provider Relations, insurance companies as well as physician offices to effectively enroll providers in CHSPP contracts as well as mitigate certain claims issues should they occur. 

Duties/Responsibilities: 

• Serve as liaison between Practice Administrators and/or Billing Managers and insurance carriers
• Respond to requests for information and telephone inquiries from Provider and insurance carriers
• Assist in the training of new and temporary staff
• Work with the insurance carriers to investigate, research, track, resolve and communicate claims issues related to payment and contractual rates
• Submit monthly rosters to payers to add/update the physician network
• Update physician practice demographic information and payer plan information in Salesforce
• Perform quality control in Salesforce and other applicable databases to ensure it reflects updated provider insurance plan information accurately and timely
• Diagnose and solve root causes around missing effective dates or claims issues with commercial payers
• Review and verify enrollment grids for accuracy
• Monitor CAQH to ensure data elements are accurate
• Coordinate the reconciliation process for assigned practices
• Report trends of payer behavior
• Stay informed on product information, changes in CMS/Commercial Payer procedures and updates in policies
• Manage short-term projects and tasks as assigned by supervisor such as payer data reconciliations
• Contribute to other company and departmental needs as requested
• Maintain a climate of teamwork and collaborating problem solving

Requirements:

• High School diploma or equivalent required.
• Strong knowledge of medical insurance and healthcare billing
• Establishes and demonstrates competency in accounts receivable systems and associated applications
• Ability to communicate effectively with insurance carriers, patients, and co-workers
• Ability to comply with procedural guidelines and instructions and to solicit assistance when situations arise that deviate from the norm.
• Excellent verbal and auditory skills are required for communicating with internal staff, customers and representatives from external departments and agencies.

This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits.

At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.