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Provider Enrollment Specialist in Tampa, FL at Shriners Hospitals for Children

Date Posted: 11/30/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    2900 North Rocky Point Drive
    Tampa, FL
  • Job Type:
  • Experience:
    At least 1 year(s)
  • Date Posted:
    11/30/2018

Job Description

As part of the Shriners Hospitals for Children (SHC) Department of Medical Affairs, the Provider Enrollment Specialist is responsible for coordinating, monitoring and maintaining provider enrollment and re-enrollment for physician/advanced practice professional providers participation in all third-party and government insurance which SHC sites participation with.  The Provider Enrollment Specialist will continuously exemplify the mission, vision, values and customer service philosophy of SHC in job performance and in service to other persons outside of and throughout the organization.

POSITION RESPONSIBILITIES:

  • Obtains and maintains provider enrollments with Commercial payors, Medicaid Managed Care plans, and multi-state Medicaid programs for assigned SHC sites to support revenue goals and telehealth initiative – 40%

    • Manages the submission of provider enrollment through the Council for Affordable Quality Healthcare (CAQH) database, via rosters and/or forms as required by payors.

    • Responsible for compiling applications for payors who do not credential through CAQH, including commercial, Medicaid Managed Care, and in and out of state Medicaid programs.

    • Coordinates with local staff to secure provider signatures as needed

    • Tracks enrollment progress, addresses deficiencies to ensure timely approvals, and confirms linking to Shriners tax ID and contract.

    • Initiates timely and appropriate actions to maintain enrollments (revalidations, re-certifications, re-credentialing, change of information, and other required updates).

    • Works closely with the external provider enrollment departments (insurance based) to discern and maintain up to date information on specific application/enrollment requirements including pre-requisites, forms required, form completion requirements, timelines, supporting documentation, and regulations. Document processes to ensure business continuance.

    • Maintains knowledge of CAQH platform and assists with CAQH as needed for coverage.

  • Maintains up-to-date enrollment status, notes and documentation in the Provider Enrollment system OnBase. Follows established processes and manual. Adds providers to appropriate health plans and groups in OnBase. Becomes subject matter expert in the use of OnBase, to promote efficient processes and enrollment data integrity. Escalates issues as needed – 20%

  • Coordinates with various departments and functions for input and reporting – 15%

    • Serves as point of contact for hospitals and headquarters with regards to provider enrollment status.

    • Addresses SHC and payor inquiries in a timely manner and includes appropriate personnel in other departments as appropriate to provide complete and accurate information on enrollment questions and concerns. Exercises independent judgment to escalate issues as appropriate.

    • Reports on status of enrollment goals established by manager

    • Regularly coordinates with key personnel at SHC sites to confirm provider prioritization and enrollment types needed for various payors based on ROI.

    • Serves as point of contact for Network Management contractors for enrollment needs to support contracting efforts

    • Works with Patient Financial Services, Revenue Cycle Manager and others to address credentialing issues causing claim or authorization denials

  • Supports a strong referral network by ensuring that key providers identified by SHC sites are listed on member directories – 5%

  • Handles enrollment with, timely monthly updates to onboarding issues, and re-credentialing of providers with national payor(s) as assigned by Manager. Point of contact for all SHC sites and Headquarters with regards to status of enrollment with assigned national payor(s) – 10%

  • Establishes and maintains close working relationships with hospital credentialing coordinators, network management, providers, other hospital/headquarter departments, and insurance payors to promote positive enrollment outcome – 5%

  • Performs other duties as assigned – 5%

Job Requirements

The qualified candidate will have experience in the following areas

  • At least 1 year of provider enrollment or credentialing experience required
  • Medicare, State Medicaid, and third party practitioner enrollment experience preferred
  • CAQH, MD-Staff credentialing database, OnBase or other credentialing/enrollment data bases preferred
  • Expertise with Adobe Pro and Microsoft software products (Excel, Word, PowerPoint, Outlook, etc.) required

Minimum Education Required/Preferred:

  • High School diploma or GED required

  • Two (2) years of college preferred

Knowledge, Skills, and Competencies:

  • Must have excellent computer skills (documentation, database management, spreadsheets, etc), Microsoft Office Applications (Excel, Word, PowerPoint, Outlook, etc.)
  • Ability to work autonomously (organized self-starter requiring little supervision to focus on and accomplish required tasks)
  • Ability to adapt to flexible work schedules and frequent interruptions
  • Ability to problem solve, make decisions and effectively communicate issues and progress
  • Knowledge of healthcare environment and healthcare delivery systems
  • Knowledge of medical provider credentialing procedures and standards
  • Database management skills including querying, reporting, and document generation
  • Maintains strict confidentiality with regard to provider information and understand/adheres to sound physicians HIPAA Privacy & Security policies and procedures
  • Must be able to communicate well with a wide variety of contacts at all levels of the organization
  • Must be able to work cohesively in a team oriented environment and be able to foster good working relationships with others both within and outside the organization
  • Strong Knowledge of Medicaid, Medicare and commercial insurance preferred

  • Well-organized, detail oriented and able to meet deadlines with minimal errors

  • Strong written, phone, and verbal communication skills; proven ability to communicate with doctors, hospital administrative and credentialing staffs

  • Ability to plan, organize, and manage multiple tasks concurrently