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:

• Completing all initial payer enrollment applications for commercial and government payers.
• Completing and maintaining all CAQH/PECOS profiles for all providers
• Completing timely follow up on all payer enrollment applications
• Completing and coordinating paperwork for ERA, EDI, EFT, and other electronic channels between the organization and payers in the electronic billing system, and with enrollment services
• Payer portal access
• Ensuring that re-credentialing and revalidations are completed timely to prevent any lapse in enrollment
• The loading and timely maintenance of credentialing and billing information in the billing and Credentialing/enrollment system
• Communicating with hospitals, payers, providers, and other entities to quickly and accurately obtain or provide information beneficial to the credentialing or enrollment needs of the organization
• Maintaining knowledge of current health plan and agency requirements for credentialing
• Ensuring practice addresses are current with government and commercial health plans, agencies and other entities
• Maintaining confidentiality of provider information
• Terminating enrollment with government and commercial payers upon resignation or termination of providers
• Updating and maintaining National Provider Identification files for providers
• Using 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
• Responding to the enrollment services dashboard tasks and overall maintenance and content
• Monitoring worklists to identify increases in accounts receivable or claims denials related to enrollment and credentialing issues, and working toward resolution
• Responsible for the day-to-day follow-ups with the payor enrollment vendor that handles our 215+ licensed providers within Hughston’s five Medical groups. This includes enrollments for 50+ various clinics, affiliated hospital and/ or surgery center locations throughout GA, AL, TN, FL.

• Assisting in other credentialing, licensing, privileging items as needed.

Experience: 3 years credentialing experience in large medical clinic/hospital setting or in payor setting required.

Education:

Required:

High school graduate or equivalent required.

Preferred:

Degree in related field preferred.

Provider Enrollment Specialist Certification (PESC) preferred.

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 duties

The 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.