Provider Enrollment Coordinator - Presbyterian Healthcare Services

Overview:

Now hiring a Provider Enrollment Coordinator!

Processes health plan payer provider enrollment applications for all PHS system-wide employed or contracted healthcare providers as needed. Along with the Provider Enrollment Manager, directs the PHS system wide provider enrollment process to assure the ability to bill for all employed, contracted health care providers for whom PHS has accepted responsibility. Generates, processes, and assures completion of provider enrollment applications with various health plans with which PHS is contracted in order to assure the ability to bill for provider services. Directs the enrollment process for employed, contracted health care providers and any others as identified by management. Keeps in contact with providers by phone, email or mail to update them as their enrollment progresses.
Generates initial application, compiles necessary related documents, obtains all necessary signatures, and assures delivery of application to health plan payers. Obtains PIN s/enrollment numbers and communicates them to applicable billing office. Strives to maintain and ensure a strong positive working relationship with Medical Staff Affairs, Credentialing Verification Office, Business Office, Contracting personnel, as well as PMG and regional administrators. Good communication and working relationship with external agencies to assure optimum sharing of information and maximization of revenue through timely enrollment.

How you belong matters here.

We value our employees' differences and find strength in the diversity of our team and community.

At Presbyterian, it's not just what we do that matters. It's how we do it - and it starts with our incredible team. From Information Technology to Food Services and beyond, our non-clinical employees make a meaningful impact on the healthcare provided to our patients and members.

Why Join Us

• Full Time - Exempt: No
• Job is based Rev Hugh Cooper Admin Center
• Work hours: Days
• Benefits: We offer a wide range of benefits including medical, wellness program, vision, dental, paid time off, retirement and more for FT employees.

Ideal Candidate:

Associates Degree preferred or at least three years of experience in a medical, business or medical staff affairs office required.

Qualifications:

• Associates Degree preferred or at least three years of experience in a medical, business or medical staff affairs office required.
• Possess strong interpersonal skills and able to relate positively to health care providers.
• Possess basic computer skills including use of Windows, MS Office and Outlook.
• Claims processing and medical terminology experience a plus

Education Essential: Associate Degree

 

 

Responsibilities:

• Assist with providing consultative support for all PMG providers and sites in regards to provider enrollment processes, licensing agencies and payers. Must also maintain current knowledge of prayer and government regulatory and licensing requirements as it pertains to their job.
• Assist department manager with delegated payer annual/quarterly or monthly audits of the Presbyterian Health Plan credentialing files.
• Maintains provider enrollment files in accordance with health plan NCQA requirements and principles of confidentiality. By analyzing practitioner applications and documents including certificates of education, residency and fellowship training, board certification, eligibility, licensure, professional work history, liability insurance and malpractice in order to accurately and completely generate enrollment applications.
• Maintains ongoing positive interactions and employs public relation skills with the Provider Navigator and Medical Staff Affairs, Presbyterian Health Plan and Credentialing Verification Office credentialing personnel. As well as external sources to develop awareness of new providers coming on board. Determines if new providers need to be enrolled with health plans, and if so what plans are applicable. Maintains ongoing positive interactions with contracting personnel to become aware of when new contracts are executed, requiring enrollment of established providers. As well as the billing department to communicate provider PIN s and Taxonomy numbers.
• Process all provider changes, (i.e. pointage, specialty, function, terminations etc.) with payers and complete any necessary applications to reflect a change in pointage or function.
• Performs audits of the credentialing database utilizing Cactus error reports, weekly change reports and weekly term reports from risk management as well as any reports from payers. As well as auditing of their own provider files with the help of the PE Manager.
• Responsible for ensuring the monthly upkeep and uploading of the Provider Directory, credentialing grid and new provider status reports on the PEL.
• Assists in educating and training new staff within the department in regards to internal departmental desktop procedures and policies.
• Assist in developing and revising the departments credentialing and enrollment policies and procedures, criteria and audit tools and desktop manual to ensure accurate and consistent processing of provider applications.
• Performs denial management activities for their assigned providers using weekly/monthly write-off reports, Medicare and Medicaid denial reports and denial issues brought to the team from other departments. Process and review write-off spreadsheet in accordance with PFS write-off policy to manager or dept analyst for advice and/or assistance. Responsible for following up on outstanding write-offs and denied claims from billing.
• Responsible for purging of termed provider files from storage and getting any newly termed provider files prepped to be scanned.
• Handle all incoming customer complaints from EWC in regards to your assigned providers. Responsible for reviewing and conducting detailed investigative research into the matter, in a timely matter to better serve PHS members.
• Serve as the department representative/point of contact for contracted payer meetings.
  
  

Benefits:

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

Inclusion and Diversity
Our culture is one of knowing and respecting our patients, members, and each other. We capture this in our Promise and CARES commitments.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

Maximum Offer for this position is up to:USD $23.07/Hr.Compensation Disclaimer:The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.