Provider Enrollment Coordinator

Overview

Unified Women’s Healthcare is a company dedicated to caring for Ob-Gyn providers who care for others, be they physicians or their support staff. A team of like-minded professionals with significant business and healthcare experience, we operate with a singular mindset - great care needs great care. We take great pride in not just speaking about this but executing on it.

As a company, our mission is to be an indispensable source of business knowledge, innovation and support to the practices in our network. We are advocates for our Ob-Gyn medical affiliates - enabling them to focus solely on the practice of medicine while we focus on the business of medicine.

We are action oriented. We strategize, implement and execute - on behalf of the practices we serve.

The Provider Enrollment Coordinator is responsible for preparing and submitting all types of credentialing/enrollment applications and supporting documentation for enrolling providers and groups with payers. The Provider Enrollment Coordinator follows up on the status of applications for all practitioners and payers, tracking progression on all pending and completed applications.

Responsibilities

• Preparing and submitting all provider credentialing applications and conducting necessary follow-up.
• Maintain follow-up guidelines for enrollment/credentialing applications and provide Care Centers with status updates. Communicate with other departments with updates as needed.
• Maintain a strict level of confidentiality for all matters pertaining to provider credentials
• Ensuring credentialing data needed for enrollment, contracting, and other related purposes is on file. Credentialing data includes but is not limited to the Medical Degree, Internship/Residency certification, Drug Enforcement Administration (DEA) verification of number, Board Certifications, CV, malpractice insurance and medical history.
• Work closely with Care Centers and provider to obtain missing documentation for providers pertaining to enrollment activities.
• Maintain provider information via Credentialing Software including demographics for all providers. The status of payer enrollment (PE) applications must be tracked in credentialing database and Salesforce.
• Maintain provider credentialing files electronically via credentialing software, shared computer files, and CAQH (Council for Affordable Quality Healthcare).
• Processes reappointment applications for the payers.
• Ability to determine the contracting status such as PHO (type of PHO) delegated or not delegated and notify manager accordingly.
• Manage new care center start-up, group enrollment and special projects.
• Notify proper departments and provider/care center of participation status with all payers as the provider becomes PAR or as requested from the provider/care center.
• Resolve issues related to provider participation.
• Conduct training as needed regarding payer enrollment
• Comply with Unified policies and procedures
• Other duties as assigned, directed, or requested
  
  

Qualifications

• Bachelor’s degree from an accredited university preferred or 3 years minimum experience in a payer enrollment related field
• Knowledge and thorough understanding of managed care operations including enrollment, credentialing, contracting and claims
• Knowledge of payer processes, local, state, and federal requirements
• Knowledge of payer delegation and rosters
• Excellent written and oral communication skills
• Demonstrated proficiency in Microsoft Office products including word, excel, and outlook
• Strong organizational, problem solving and decision-making skills
• Ability to prioritize and manage multiple issues effectively and simultaneously
• Self-motivated and self-starter who can work well under minimal supervision
• Strong attention to detail, research and follow up skills
• Ability to work both independently and in a team setting
• Excellent planning, organizational, and time management skills required.
• Able to learn and adapt to continuously changing business and technology needs.
• Extend work hours, if required depending on deadlines and events
  
  

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