Job description
Company Overview:
Shriners Children’s is a family that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience defines us as leaders in pediatric specialty care for our children and their families. Job Overview:
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 with which Shriners Children's sites participates. The Specialist will exemplify the mission, vision, values and customer service philosophy of Shriners Hospitals for Children in job performance and in service to other persons outside of and throughout the organization.
Shriners Children's is an EOE/Drug-Free, Smoke-Free Workplace Responsibilities:
Education Required/Preferred:
Knowledge, Skills & Abilities:
Current full Covid vaccination status required
#LI-Remote
Shriners Children’s is a family that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience defines us as leaders in pediatric specialty care for our children and their families.
Shriners Children's is the premier pediatric burn, orthopaedic, spinal cord injury, cleft lip and palate, and pediatric subspecialties medical center. We have an opportunity for a remote Provider Enrollment Specialist reporting into our Headquarters location.
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 with which Shriners Children's sites participates. The Specialist will exemplify the mission, vision, values and customer service philosophy of Shriners Hospitals for Children in job performance and in service to other persons outside of and throughout the organization.
Shriners Children's is an EOE/Drug-Free, Smoke-Free Workplace
Position Responsibilities:
- Manages the completion and submission of provider applications for enrollment in all commercial insurance, Medicaid Managed Care and government plans for multiple locations in the Shriners Hospitals for Children system. Tracks and maintains enrollments through timely re-validations. Follows strict guidelines to protect providers’ information, and maintain confidentiality. 20%
- Works closely with the insurance enrollment departments to discern specific enrollment requirements including pre-requisites, forms, documentation, and timelines. Establishes relationships at the health plans necessary to promote swift enrollment turnaround time. Performs follow-up with insurance payors via phone, email, fax or website to resolve provider enrollment issues. Negotiates to overcome roadblocks.
- Collaborates with Health Plan Liaisons to address unresponsive health plans or streamline enrollment processes.
- Maintains accurate records of enrollment activities in OnBase, including but not limited to, maintaining enrollment data, documenting activities through notes, tracking progress on enrollment worksheets, uploading enrollment related documentation and communications, for access by all team members, and to ensure business continuance.
- Establishes providers’ CAQH (Council for Affordable Quality Healthcare) profiles. Maintains profiles up to date, uploading documents as required, and re-attesting profiles every 120 days. Maintains MCC (Minnesota Credentialing Collaborative) Profiles for providers at our Minnesota location, if applicable.
- Coordinates with hospital staff to obtain provider signatures and additional data necessary for enrollments. Establishes and maintains positive relationships with staff, both at the hospitals and Headquarters.
- Prioritize workload to promote hospital revenue goals, and to support Network Management contracting efforts as needed.
- Point of contact for hospitals and HQ personnel for questions relating to enrollment with commercial insurance, Managed Care plans, and government payers. Addresses inquiries in a timely manner, including appropriate personnel, and escalates issues as appropriate.
Experience Required/Preferred:
- 1 year of provider credentialing experience required
- CAQH, MD-Staff credentialing database, Onbase or other credentialing/enrollment data bases preferred
- Expertise with Adobe Acrobat Pro and Microsoft Office (Excel, Word, PowerPoint, Outlook) required
Education Required/Preferred:
- High School Degree required
- Associate's Degree preferred
- Credentialing certification preferred
Knowledge, Skills & Abilities:
- 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
- Able to plan, organize, and manage multiple tasks concurrently
Current full Covid vaccination status required
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