Matrix Medical Management
Provider Enrollment Coordinator
Matrix Medical Management, Sacramento, California, United States, 95828
Premier Medical Resources is looking for a Provider Enrollment (Credentialing) Coordinator to join our team!
The Provider Enrollment (Credentialing) Coordinator is responsible for the enrollment of providers with various payers for professional services reimbursement. The Provider Enrollment (Credentialing) Coordinator reviews provider credentialing and/or recredentialing data for accuracy based on licensing requirements and various insurer payer requirements. Obtaining information from professional providers and other sources.
ESSENTIAL FUNCTIONS Onboarding
Issue contracts to providers based on their statuses (1099, W2, locum) and monitor their status for timely completion
Collaborate with Human Resources to ensure provider inquiries are resolved in a timely and effective manner
Conduct provider onboarding and orientation to the practice
Communicate updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and teamwork with departments, vendors, etc.
Support new provider onboarding processes as related to enrollment.
Credentialing
Coordinate credentialing data needed for enrollment. Credentialing data includes but is not limited to the Medical Degree, Drug Enforcement Administration (DEA) number, and state license number, Board certifications, Curriculum Vitae (CV), and liability insurance.
Complete provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner.
Completing timely application processes based on payer specific formats
Resolve enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others as identified.
Explain and inform providers and practice/office managers of the submission requirements for credentialing and recredentialing processes.
Ensure the importance of compliance with credentialing/recredentialing processes is expressed
Update on-site practice management and staff of any changes to requirements for credentialing individual providers based on government and commercial payer credentialing processes
Communicate any changes regarding contracting as it relates to enrollment and operations proactively
Administrative
Manage surgery assignments schedules and distribution
Manage contracts with providers and coordinate onboarding with HAA and PMR
Ensures providers remain compliant with state federal regulations and company policies and procedures
Maintain updated provider credentialing data, acting prior to expiration, completing all additions, updates, and deletions
Obtain updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc.
Follow up continuously on enrollment and/or recredentialing statuses until complete
Resolve issues as they are identified in a timely manner with primary source verification elements by interpreting, analyzing, and researching data
Implement the entire enrollment process for all providers successfully, adhering to all timelines while maintaining strict confidentiality for matters pertaining to provider credentials
Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions
Maintains systems/applications used in the enrollment processes
Develop databases and spreadsheets for tracking the organizations providers.
Ensures data is accessible and transparent for executive inquiries or other information as deemed necessary by management
Continuously searches for process improvements to achieve accuracy and efficiencies.
Performs other duties as assigned or required.
KNOWLEDGE, SKILLS, AND ABILITIES
Knowledge and understanding of credentialing process
Ability to organize and prioritize work and manage multiple priorities
Excellent verbal and written communication skills including letters, memos, and emails
Excellent attention to detail
Ability to research and analyze data
Ability to work independently with minimal supervision
Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization
Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.
Maintain positive working relationships with providers
Experience with professional provider credentialing software (PECOS, NPPES, CMS, etc.)
EDUCATION AND EXPERIENCE
Associate Degree or 2 years of experience in lieu of education
One (1) year of recent provider enrollment/credentialing experience
Premier Medical Resources is a healthcare management company headquartered in Northwest Houston, Texas. At Premier Medical Resources, our goal is to leverage and combine the expertise and skillset of our employees to drive quality in all we do. Our goal is to create career pathways for our employees just starting their professional career, and to those who seek to bring their expertise and leadership as we strive to combine best practices and industry excellence. Come join our team at Premier Medical Resources where passion and career meet.
Compensation to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, and alignment with market data. Employment for this position is contingent upon the successful completion of a background check and drug screening.
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The Provider Enrollment (Credentialing) Coordinator is responsible for the enrollment of providers with various payers for professional services reimbursement. The Provider Enrollment (Credentialing) Coordinator reviews provider credentialing and/or recredentialing data for accuracy based on licensing requirements and various insurer payer requirements. Obtaining information from professional providers and other sources.
ESSENTIAL FUNCTIONS Onboarding
Issue contracts to providers based on their statuses (1099, W2, locum) and monitor their status for timely completion
Collaborate with Human Resources to ensure provider inquiries are resolved in a timely and effective manner
Conduct provider onboarding and orientation to the practice
Communicate updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and teamwork with departments, vendors, etc.
Support new provider onboarding processes as related to enrollment.
Credentialing
Coordinate credentialing data needed for enrollment. Credentialing data includes but is not limited to the Medical Degree, Drug Enforcement Administration (DEA) number, and state license number, Board certifications, Curriculum Vitae (CV), and liability insurance.
Complete provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner.
Completing timely application processes based on payer specific formats
Resolve enrollment issues through collaboration with physicians, non-physicians, office staff, management, contracting, insurers, and others as identified.
Explain and inform providers and practice/office managers of the submission requirements for credentialing and recredentialing processes.
Ensure the importance of compliance with credentialing/recredentialing processes is expressed
Update on-site practice management and staff of any changes to requirements for credentialing individual providers based on government and commercial payer credentialing processes
Communicate any changes regarding contracting as it relates to enrollment and operations proactively
Administrative
Manage surgery assignments schedules and distribution
Manage contracts with providers and coordinate onboarding with HAA and PMR
Ensures providers remain compliant with state federal regulations and company policies and procedures
Maintain updated provider credentialing data, acting prior to expiration, completing all additions, updates, and deletions
Obtain updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc.
Follow up continuously on enrollment and/or recredentialing statuses until complete
Resolve issues as they are identified in a timely manner with primary source verification elements by interpreting, analyzing, and researching data
Implement the entire enrollment process for all providers successfully, adhering to all timelines while maintaining strict confidentiality for matters pertaining to provider credentials
Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions
Maintains systems/applications used in the enrollment processes
Develop databases and spreadsheets for tracking the organizations providers.
Ensures data is accessible and transparent for executive inquiries or other information as deemed necessary by management
Continuously searches for process improvements to achieve accuracy and efficiencies.
Performs other duties as assigned or required.
KNOWLEDGE, SKILLS, AND ABILITIES
Knowledge and understanding of credentialing process
Ability to organize and prioritize work and manage multiple priorities
Excellent verbal and written communication skills including letters, memos, and emails
Excellent attention to detail
Ability to research and analyze data
Ability to work independently with minimal supervision
Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization
Proficient use of Microsoft Office applications (Word, Excel, Access) and internet resources.
Maintain positive working relationships with providers
Experience with professional provider credentialing software (PECOS, NPPES, CMS, etc.)
EDUCATION AND EXPERIENCE
Associate Degree or 2 years of experience in lieu of education
One (1) year of recent provider enrollment/credentialing experience
Premier Medical Resources is a healthcare management company headquartered in Northwest Houston, Texas. At Premier Medical Resources, our goal is to leverage and combine the expertise and skillset of our employees to drive quality in all we do. Our goal is to create career pathways for our employees just starting their professional career, and to those who seek to bring their expertise and leadership as we strive to combine best practices and industry excellence. Come join our team at Premier Medical Resources where passion and career meet.
Compensation to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, and alignment with market data. Employment for this position is contingent upon the successful completion of a background check and drug screening.
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