Job Summary
The provider enrollment specialist’s primary job function is to be responsible for managing and enrolling providers with nondelegated health plans, maintaining delegated credentialing, and coordinating facility health plan credentialing. This position requires a high degree of organization, planning, and attention to detail.
1. Responsible for completing and submitting enrollment applications to credential providers with nondelegated health plans, Labor and Industries, Medicaid and Medicare.
2. Maintains CAQH applications for provider credentialing and recredentialing.
3. Maintains National Provider Plan Enumerator System (NPPES) individual and facility information for National Provider Identifiers (NPIs).
4. Verifies and updates health plan directories to ensure accuracy of providers and practice address information.
5. Maintains current information on provider enrollment status for all staff.
6. Maintains facility credentialing with Medicaid, Medicare and Managed Care Organizations.
7. Responsible for maintaining current knowledge of general billing guidelines, reimbursement rules and regulations.
8. Coordinates with the Billing Lead and Revenue Cycle Analyst on provider set up in Athena and NextGen.
1. Performs other duties and tasks as assigned by supervisor.
2. Expected to meet attendance standards and work the hours necessary to perform the essential functions of the job.
3. Conforms to safety policies, general housekeeping practices.
4. Demonstrates sound work ethics, flexible, and shows dedication to the position and the community.
5. Demonstrates a positive attitude, is respectful, and possesses cultural awareness and sensitivity toward clients and co-workers.
6. Keeps customer service and the mission of the organization in mind when interacting with all clients, co-workers, and others.
7. Employees are expected to embrace, support and promote the core values of respect, integrity, trust, compassion and quality which align with the CVCH mission statement through their actions and interactions with all patients, staff, and others.
8. Conforms to CVCH policies and Joint Commission and HIPAA regulations.
EDUCATION
High School graduate or equivalent. Some college or equivalent combination of education and experience preferred.
CERTIFICATIONS/LICENSURE
N/A
TELECOMMUTING
Benefits
*Coverage below based on a 1.0 FTE; Medical, Dental, Paid Leave, Holidays are prorated based on FTE
Benefit: |
Coverage: |
Effective: |
Medical Premera (Self Insured) Preferred Provider |
Employee covered - $60.00 per month Dependents covered – please refer to the benefits Guide 2025 for rates |
First of the month following the first date of employment. |
Dental Washington Dental |
Employee covered – 100% Dependents covered – 50% |
First of the month following the first date of employment. |
Paid Leave |
120 hours – Year 1 136 hours - Year 2 |
Paid Leave may be used immediately for sick leave and after 3 months employment for vacation. Maximum accrual cap of 320 hours; hours in excess of 320 hours will automatically transfer into the employees EIB. |
Extended Illness Bank (EIB) |
Allows for maximum accrual of 200 hours |
PTO hours in excess of 320 will transfer into EIB. Employees are eligible to use EIB hours after at least 3 consecutive scheduled working days of PTO (max 24 hours) which have been used for a personal illness and/or a qualifying event under FMLA or the WA Family Care Act. |
Holidays |
88 hours related to: · New Year’s Day · Memorial Day · 4th of July · Labor Day · Thanksgiving Day · Day after Thanksgiving · Christmas Eve · Christmas Day · 3 Diversity Days |
Holidays are calculated as 8-hour days if full time, 1.0 FTE, and paid based on the calendar year (January 1 through December 31). Holiday hours will be added to the employee’s timecard automatically. If an employee is part-time, as documented in our HR/Payroll system, Holiday hours will be pro-rated. If an employee starts after the calendar year has begun, holiday hours will be prorated based on remaining holidays in the calendar year and diversity days will be prorated as outlined below: · Jan 1- April 30: 3 diversity days (24 hours if 1.0 FTE) · May 1 – August 31: 2 diversity days (16 hours if 1.0 FTE) · Sept 1 – Dec 31: 1 diversity day (8 hours if 1.0 FTE) Please refer to the Paid Leave policy for additional details. |
403(b) Retirement Plan Lincoln Financial |
150% CVCH match up to 3% of the employee’s contribution |
Immediately. Vesting schedule: 20% at 2 years, 50% at 3 years, 60% at 4 years, and 100% at 5 years. |
Employee Assistance Program Mutual of Omaha |
Free short-term counseling for employee and family |
Immediately. Call 800-316-2796 |
Long-term Disability Mutual of Omaha |
Employee Only (variable) |
First of the month following the first date of employment. |
Benefit: |
Coverage: |
Effective: |
Basic Term Life Mutual of Omaha |
Employee Only (1x annual salary, up to $200,000) |
First of the month following the first date of employment. |
Group Accidental Death and Dismemberment (AD&D) Mutual of Omaha |
Employee Only (1x annual salary, up to $200,000) |
First of the month following the first date of employment. |
Supplemental Term Life Mutual of Omaha |
Employee / Spouse / Dependent(s) |
First of the month following the first date of employment. |
Voluntary AD&D Mutual of Omaha |
Employee / Family |
First of the month following the first date of employment. |
Health Reimbursement Arrangement RedQuote |
Reimbursement for out of pocket expenses for services received at CVCH (medical, dental, and prescription) by employees and their dependents enrolled in our medical plan. Up to $750 per family per year. |
First of the month following the first date of employment. |
Flex Plan: Medical RedQuote |
Flex Plan: Maximum $3,300 per year Direct Deposit available |
First of the month following the first date of employment. |
Flex Plan: Dependent Care RedQuote |
Flex Plan: Maximum $5,000 per year Direct Deposit available |
First of the month following the first date of employment. |
AFLAC |
Supplemental insurance – cafeteria plan |
First of the month following the first date of employment. |
Wellness Stipend |
CVCH will reimburse staff up to $30 per month for a local gym membership OR CVCH will reimburse up to $150 per year for a subscription type workout program service (i.e.: Beachbody on Demand, Les Mills, etc.) |
Immediately. Once employee has submitted invoice to HR/Payroll department. |
Cell Phone Discounts |
Discounted monthly access fees Discounted select accessories and special equipment |
Available for personal cell phones, currently in place with AT&T & Verizon |
Benefit: |
Coverage: |
Effective: |
Tuition Reimbursement |
For approved courses, the cost of tuition, books, and lab fees may be reimbursed at 75% of the actual costs up to a maximum of: · $4,000 for an Associate’s degree, vocational, technical, or certification program · $6,000 for a Bachelor’s degree · $8,000 for a Master’s degree |
Upon approval; regular employees who work at least 20 hours per week, have successfully passed their evaluation period and are in good standing may apply.
Employees must agree to work for a period of two (2) years from the date of receipt of tuition reimbursement and obtain satisfactory completion of approved courses or Challenge Exams. |
Compensation:
$23.58-$35.70/hourly (based on experience)
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