Position Goal

Maintaining proper understanding of onboarding, privileging, and licensing providers to include the period to complete the credentialing process. Serves as the main contact between clinic, facilities and medical boards on requests and processes.

Position Responsibilities:

• Complete all initial payer enrollment applications for assigned payers.
• Complete and maintain all CAQH/PECOS profiles for all providers.
• Complete timely follow up on all payer enrollment applications.
• Complete and coordinate paperwork for ERA, EDI, EFT, and other electronic channels between the organization and payers in the electronic billing system, and with enrollment services.
• Ensure that payer e-credentialing and revalidations are completed timely to prevent any lapse in enrollment.
• Load and maintain enrollment approvals and effective dates in Athena and enrollment system timely.
• Communicate with payers, providers, and other entities to quickly and accurately obtain or provide information beneficial to the enrollment needs of the organization.
• Maintain knowledge of current health plan and agency requirements for credentialing/enrollments.
• Ensure practice addresses are current with government and commercial health plans, agencies and other entities by continuously updating rosters as payer directories.
• Maintain confidentiality of provider information.
• Terminate enrollment with government and commercial payers upon resignation or termination of providers.
• Update and maintain National Provider Identification files for providers.
• Use the electronic billing system, along with any of the organization’s proprietary spreadsheets or software, purchased or leased, as the primary source of immediate notification and maintenance of enrollment related data.
• Respond to the enrollment services dashboard tasks and overall maintenance and content.
• Monitor worklists to identify increases in accounts receivable or claims denials related to enrollment and credentialing issues and work towards resolution.
• Responsible for the day-to-day follow-ups for enrolled providers across Hughston’s enterprise. This includes enrollments for 50+ various clinics, affiliated hospital and/ or surgery center locations throughout GA, AL, TN, FL.
• Assist in other credentialing, licensing, privileging items as needed.

Experience:

Required:

One year of direct payor enrollment experience or three years of related credentialing experience in a large medical clinic/hospital setting or in a payor setting.

Education:

Required:

• High school graduate or equivalent.

Preferred:

• Advanced degree in related field.

Provider Enrollment Specialist Certification (PESC)..

Special Qualifications:

Required:

• Ability to work independently with minimal supervision.
• Requires skill in computer systems and applications.
• Must have outstanding organizational and oral/written communication skills.
• Must be able to prioritize work to meet deadlines despite frequent interruptions.
• Ability to work in a team environment.

Must be able to prioritize tasks and use good professional judgment in assigned dutiesThe Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.