At SCP Health, what you do matters
As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.
Why you will love working here:
- Strong track record of providing excellent work/life balance.
- Comprehensive benefits package and competitive compensation.
- Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.
Primary Duties and Responsibilities:
- Process and maintain provider applications for enrollment and re-enrollment for Medicare, Medicaid, BCBS and/or Commercial payors in accordance with Federal and State guidelines.
- Prioritize and manage multiple enrollments in a deadline-driven environment.
- Distribute, log, receive and scan Provider Enrollment Packets as assigned.
- Update National Provider Database information as needed.
- Monitor credentials, i.e. Medical License, DEA to ensure they are active and in good standing.
- Submit updated credentials to payors when credentials have expired to ensure no lapse in enrollment.
- Serve as the primary contact for providers and payors when questions regarding enrollment/re-enrollment arise.
- Identify any issues with providers eligibility to participate in Government plans.
- Advise Supervisor/Manager immediately of any eligibility issues for providers.
- Procure all documents needed from Provider to enroll timely. Escalate to MSL on non-response providers.
- Perform data entry of submitted applications in Provider database record along with any documentation related to the enrollment process.
- Perform follow up on submissions via online, email or phone according to policies and procedures to ensure timely approval is received.
- Maintain accurate database information and perform data quality cleanup activities as directed by Management.
- Maintain confidentiality of privileged information.
- Work in CAQH database and maintain/update providers’ credentials every 90 days.
- On occasion, may be required to be onsite at client facility to distribute PEPs and help facilitate in person enrollment.
- Once approval is received from payors, document approval and effective dates in Provider Enrollment system to ensure approvals and information are pushed to Billing System for release of claims.
- Monitor changes to payor requirements through payor websites, bulletins, emails, etc and communicate any changes to appropriate Managers to ensure changes are made wherever applicable.
Required Skills and Qualifications:
- Work independently utilizing documented processes and automated daily reports generated from database.
- When payor requirements change, must be able to analyze and compare processes in order to recommend process solutions to Management.
- Agility in managing multiple priorities with strong organizational and time management skills.
- Knowledge of Payor Credentialing processes, both Par and Non-Par.
- Knowledge of Provider Credentials.
- Experience working in CAQH database and National Provider Identifier database
- Knowledge of CMS Regulations and guidelines.
- Proficient in Microsoft Office applications including Word and Excel.
- Ability to foster a cooperative and respectful work environment.
- Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
- Ability to communicate effectively both orally and in writing.
- Minimum 3 years of Provider Enrollment/Payor Credentialing experience required.
Preferred Skills and Qualifications:
- Experience with Availity and other provider related credentialing/enrollment databases.
- Experience working with Medicare, Medicaid or any Commercial payor.
- Experience working with Credentialing/Enrollment software.
EDUCATION:
- HS Diploma required.
- 2 years college or equivalent experience preferred.
FIELD OF STUDY:
- Healthcare Administration
- Business Administration
CERTIFICATES AND LICENSES: (Preferred)
- PESC (Provider Enrollment Specialist Certificate)
- CPCS (Certified Provider Credentialing Specialist)
PRIMARY LOCATION:
Pay Range:
13.00 - 19.00 USD per hour
This range represents the anticipated base salary for this role. Actual compensation will be determined based on experience, qualifications, and internal equity considerations.
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We offer a comprehensive benefits package designed to support your health, financial well-being, and work-life balance, including medical dental, vision insurance, a 401(k) plan with a company match, paid time off and holidays, professional development support, and employee wellness resources.
Visit our website for further information. https://myscpbenefits.com/
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