Provider Enrollment Specialist

Job Number 69884
Posted 2/11/2020
Account Northern Light Health Home Office
Department Credentialing
Location |ME| Northern Light Health Home Office - Douglas Brown Bldg., Ban, ME 04401
Schedule Regular Full-time
Shift Day
Hours 8am - 4:30 PM
Job Details
Job Summary : The Provider Enrollment Specialist is responsible for the timely submission of provider enrollment applications to governmental and commercial payers and for performing the tracking and follow-up required until providers are established and linked to the appropriate EMHS group entity.

Job Functions and Duties

- Manage the successful completion and submission of provider enrollment applications.

- Perform tracking and follow-up to ensure providers are established and linked to the appropriate EMHS group entity in a timely manner.

- Understand specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation and regulations

- Maintain documentation and reporting regarding provider enrollments in process.

- Maintain provider enrollment files electronically via EMHS credentialing software, shared computer files and CAQH (Council for Affordable Quality Healthcare).

- Work closely with departments credentialing staff and member hospitals to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc..

- Ensure that established provider IDs and effective dates are communicated to appropriate billing and revenue departments so claims can be processed for submission.

- Maintain provider enrollment information within the EMHS credentialing database.

- Establish close working relationships within department and with various departments across system.

- Process and distribute appropriate correspondence.

- Maintain working knowledge of applicable regulations, policies and procedures.

- Represent the office to internal and external customers as appropriate.

- Perform miscellaneous job-related duties as assigned.

Note: The duties listed above reflect the majority of the duties of this job and does not, nor is it intended to, reflect all duties that may be required for an incumbent in this job to perform.

Required Education and Experience:

- Associates degree or high school diploma/equivalent with at least 2 years of medical office experience

- General understanding of the medical staff organization and Joint Commission/Healthcare Facilities Accreditation Program/National Committee for Quality Assurance standards. State/federal/licensure regulations, particularly as it relates to the provider enrollment

- Experience with Microsoft Office products, including but not limited to Excel and Outlook

Preferred Education and Experience:

- Bachelor's degree

- NAMSS Certification as a Certified Provider Credentials Specialist (CPCS) or Certified Professional Medical Services Manager (CPMSM)

- NAMSS Certification as either Certified Professional Medical Services Manager (CPMSM) or Certified Provider Credentials Specialist (CPCS)

- Affiliation and participation with the Maine Association Medical Staff Services

Knowledge, Skills, and Abilities

- Excellent attention to details

- Ability to research and analyze documents.

- Ability to work independently, set priorities and meet deadlines with minimal supervision

- Strong working knowledge of word processing, spreadsheets, data entry, data base experience and other computer related skills. Experience with other Microsoft Office products and HealthLine

- Systems ECHO credentialing software preferred.

- Ability to communicate effectively, both orally and in writing.

- Must be able to communicate well with a wide variety of contacts at all levels of the organization.

- Must be able to work cohesively in a team oriented environment and be able to foster good working relationships with others both within and outside the organization.

- Ability to maintain confidentiality, work with deadlines and manage multiple priorities.

- Ability to maintain a high degree of professionalism and independent judgment in response to complex sensitive issues and decision-making.

- Ability to understand contracting and billing practices relating to EMHS provider enrollment.

Physical Requirements

- Works in a normal office environment, requiring the ability to frequently respond to unpredictable situations. Time may be spent sitting at a computer, collaborating with other healthcare team members. Able to work sitting at work station, using a keyboard, working in front of a video display monitor most of the day.

- Repetitive wrist and hand motion.

- Extended use of telephone.

- Ability to reach and stretch intermittently.

- Moderate walking throughout the facility.

- Light lifting of files and manuals

- Occasional long and irregular hours

- Must be willing to travel by air and ground.

- Tolerance for frequent interruptions

- Flexibility, dexterity, visual acuity, hearing acuity.

- Able to speak and communicate clearly and effectively.

- Able to adapt to frequently changing work priorities.

- Able to travel to various EMHS/non-EMHS sites as there may be occasional travel for offsite meetings, education and/or conference(s).

Equal Opportunity Employment
We are an equal opportunity, affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, age, disability status, gender, sexual orientation, ancestry, protected veteran status, national origin, genetic information or any other legally protected status.

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