Winnebago Comprehensive Healthcare System
Provider/Payer Enrollment and Contracting Specialist (On-Site)
Winnebago Comprehensive Healthcare System, Winnebago, Nebraska, United States, 68071
Job Details
Job Location Winnebago Comprehensive Healthcare System - IDC - Winnebago, NE
Position Type Full Time
Salary Range $32.77 - $41.13 Hourly
Description
Job Purpose & Position Overview
The Provider/Payer Enrollment and Contracting Specialist will be responsible for managing and facilitating the enrollment and re-enrollment process with third-party payers as well as assisting the CFO in Insurance contracting negotiations.
This role involves ensuring that all provider credentials are up-to-date, accurate, and compliant with payer requirements and regulatory standards.
Additionally, this role will also be responsible for assisting with payer and provider contracting negotiations and ensuring that contracts are updated as WCHS scope changes occur.
Specific Job Duties/Responsibilities: Enrollment
Initiate and complete the enrollment and re-enrollment process for providers with various payers. Prepare and submit enrollment applications and supporting documentation. Maintain accurate and up-to-date records of provider credentials, licenses, certifications, and other necessary documentation.
Payer Relations
Serve as the primary point of contact for enrollment-related inquiries and issues. Monitor and track payer contracts, agreements, and enrollment status. Ensure timely and accurate submission of all required documentation to payers. Resolve payer and provider enrollment related denials to ensure accurate processing and reimbursement of expected revenue.
Compliance & Quality Assurance
Verify that all enrollment practices comply with federal, state, and payer-specific regulations. Conduct routine audits of provider files to ensure compliance and address any discrepancies. Stay informed about changes in payer policies, procedures, and regulations.
Reporting & Documentation
Prepare and generate reports on credentialing status and payer-related activities. Maintain detailed records of all communications and transactions related to credentialing. Ensure that contracts are beneficial to WCHS patients and that payers are paying correctly.
Collaboration & Support
Work closely with internal teams, including provider relations, billing, and administrative staff, to ensure smooth enrollment processes. Provide support and training to staff regarding enrollment procedures and requirements. Collaborate with Director of Revenue Cycle to ensure that payer edits are maintained to identify over/underpayments. Resolve issues with payer liaisons. Communicate and work special payer projects (e.g. underpayments/unwarranted denials).
Qualifications
Required Qualifications/Skills:
Education:
Associate's degree in Business Administration, Healthcare Administration, or related field; Bachelor's degree preferred. Certification:
Certified Provider Enrollment Specialist (CPES) or certification eligible preferred. Experience:
Minimum of 2-3 years of experience in payer credentialing, provider relations, or a related field. Knowledge:
Strong understanding of credentialing and contracting processes, payer policies, and healthcare regulations. Skills:
Excellent organizational and multitasking abilities. Strong attention to detail and accuracy. Effective communication and interpersonal skills. Proficiency in Microsoft Office Suite (Word, Excel, Outlook). Familiarity with credentialing software and databases.
Physical Requirements:
Normal to light office work which includes the ability to lift up to 10 lbs. Regularly required to walk, stand, and sit for extended periods of time and use hands to operate computer keyboard, phone, and various office equipment. While performing daily duties, the employee is regularly required to talk and hear. Mental Requirements:
Reading, writing, calculating Above average social interaction skills Excellent reasoning/Analysis skills Works with minimal supervision. Language Requirements:
Must possess the ability to read, write, and speak the English language fluently. Must be able to continually and effectively employ professional verbal and written communications skills. Certificates, Licenses & Registrations:
All applicants will comply with 45 CFR 1301, Subpart D, Section 1301.31, C and D, which require all prospective employees to sign a declaration prior to employment regarding all arrests and convictions of child abuse or violent felonies and to comply with PL 101-630 and PL 101-637 regarding criminal records check.
WCHS is an equal opportunity employer. Employment practices are free of discrimination. As provided by Federal Law, all qualified Native American applicants shall receive preference over Non-Native American applicants. In the absence of qualified Native American applicants, consideration will be given to all other applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, marital status, veteran status, genetic information, disability or any other reason prohibited by law in provision of employment opportunities and benefits.
Please note the position description duties, responsibilities, and activities may change at any time with or without notice.
Job Location Winnebago Comprehensive Healthcare System - IDC - Winnebago, NE
Position Type Full Time
Salary Range $32.77 - $41.13 Hourly
Description
Job Purpose & Position Overview
The Provider/Payer Enrollment and Contracting Specialist will be responsible for managing and facilitating the enrollment and re-enrollment process with third-party payers as well as assisting the CFO in Insurance contracting negotiations.
This role involves ensuring that all provider credentials are up-to-date, accurate, and compliant with payer requirements and regulatory standards.
Additionally, this role will also be responsible for assisting with payer and provider contracting negotiations and ensuring that contracts are updated as WCHS scope changes occur.
Specific Job Duties/Responsibilities: Enrollment
Initiate and complete the enrollment and re-enrollment process for providers with various payers. Prepare and submit enrollment applications and supporting documentation. Maintain accurate and up-to-date records of provider credentials, licenses, certifications, and other necessary documentation.
Payer Relations
Serve as the primary point of contact for enrollment-related inquiries and issues. Monitor and track payer contracts, agreements, and enrollment status. Ensure timely and accurate submission of all required documentation to payers. Resolve payer and provider enrollment related denials to ensure accurate processing and reimbursement of expected revenue.
Compliance & Quality Assurance
Verify that all enrollment practices comply with federal, state, and payer-specific regulations. Conduct routine audits of provider files to ensure compliance and address any discrepancies. Stay informed about changes in payer policies, procedures, and regulations.
Reporting & Documentation
Prepare and generate reports on credentialing status and payer-related activities. Maintain detailed records of all communications and transactions related to credentialing. Ensure that contracts are beneficial to WCHS patients and that payers are paying correctly.
Collaboration & Support
Work closely with internal teams, including provider relations, billing, and administrative staff, to ensure smooth enrollment processes. Provide support and training to staff regarding enrollment procedures and requirements. Collaborate with Director of Revenue Cycle to ensure that payer edits are maintained to identify over/underpayments. Resolve issues with payer liaisons. Communicate and work special payer projects (e.g. underpayments/unwarranted denials).
Qualifications
Required Qualifications/Skills:
Education:
Associate's degree in Business Administration, Healthcare Administration, or related field; Bachelor's degree preferred. Certification:
Certified Provider Enrollment Specialist (CPES) or certification eligible preferred. Experience:
Minimum of 2-3 years of experience in payer credentialing, provider relations, or a related field. Knowledge:
Strong understanding of credentialing and contracting processes, payer policies, and healthcare regulations. Skills:
Excellent organizational and multitasking abilities. Strong attention to detail and accuracy. Effective communication and interpersonal skills. Proficiency in Microsoft Office Suite (Word, Excel, Outlook). Familiarity with credentialing software and databases.
Physical Requirements:
Normal to light office work which includes the ability to lift up to 10 lbs. Regularly required to walk, stand, and sit for extended periods of time and use hands to operate computer keyboard, phone, and various office equipment. While performing daily duties, the employee is regularly required to talk and hear. Mental Requirements:
Reading, writing, calculating Above average social interaction skills Excellent reasoning/Analysis skills Works with minimal supervision. Language Requirements:
Must possess the ability to read, write, and speak the English language fluently. Must be able to continually and effectively employ professional verbal and written communications skills. Certificates, Licenses & Registrations:
All applicants will comply with 45 CFR 1301, Subpart D, Section 1301.31, C and D, which require all prospective employees to sign a declaration prior to employment regarding all arrests and convictions of child abuse or violent felonies and to comply with PL 101-630 and PL 101-637 regarding criminal records check.
WCHS is an equal opportunity employer. Employment practices are free of discrimination. As provided by Federal Law, all qualified Native American applicants shall receive preference over Non-Native American applicants. In the absence of qualified Native American applicants, consideration will be given to all other applicants without regard to race, color, religion, sex, sexual orientation, national origin, age, marital status, veteran status, genetic information, disability or any other reason prohibited by law in provision of employment opportunities and benefits.
Please note the position description duties, responsibilities, and activities may change at any time with or without notice.