Search for Jobs Near You...

Radius:

Category:

Industries:

Date Posted:

Full Time

Part Time

Contractor

Intern

Seasonal

Temporary to Hire

Salary:

Per Hour

Per Year

Other

Credentialing & Provider Enrollment Lead (Temporary) 36 hrs/wk.

PURPOSE OF THIS POSITION The purpose of this position is to oversee and lead the functions and activities of provider credentialing...

Job Views ( 18 )

Findlay, Ohio

Hancock County

3/16/2021

Apply Now

Job Description

PURPOSE OF THIS POSITION

The purpose of this position is to oversee and lead the functions and activities of provider credentialing and enrollment activities with governmental payers, commercial and managed care payers and networks for BVHS facilities, entities and employed or contracted physicians, including maintaining current knowledge on requirements. Leads the team responsible for performing credentialing and provider enrollment, including assigning work requirements, duties and work timelines. Leads communication with internal and external parties on credentialing and provider enrollment process, to support the timely, accurate and complete credentialing, re-credentialing and enrollment of all BVHS facilities, entities and employed/contracted physicians and midlevel providers in governmental and payer plans and networks, as well as to address inter and intra-organizational issues that affect the processes. Participates as subject matter expert on project planning teams. Oversees the structure and use of the credentialing and enrollment database(s). Oversees and performs customer service for managed care division.

JOB DUTIES/RESPONSIBILITIES

Duty 1: Leads, organizes and oversees the processes and functions of credentialing and provider enrollment to optimize efficiency and timeliness. Assigns workload and priorities to credentialing specialist support staff.

Duty 2: Oversees the structure of and sets parameters for use of credentialing and enrollment database(s) for professional providers and entities and makes available as appropriate for use by patient revenue cycle.

Duty 3: Maintains current knowledge on CMS and other government entities’ provider enrollment requirements and payer credentialing requirements. Acts as a subject matter expert for internal projects and issues. Proactively monitors upcoming changes in or expansion of credentialing and enrollment rules and regulations; takes necessary steps to alert appropriate parties within BVHS to changes; and leads activities to maintain BVHS compliance with changes.

Duty 4: Leads communication with internal and external parties on credentialing and provider enrollment process, to support the timely, accurate and complete credentialing, re-credentialing and enrollment of all BVHS facilities, entities and employed/contracted physicians and midlevel providers in governmental and payer plans and networks, as well as to address inter and intra-organizational issues that affect the processes. Communicates directly with payers for resolution of credentialing and contract related claims payment issues.

Duty 5: Collects, completes and submits timely, accurate and complete provider enrollment and credentialing applications and information to commercial and governmental payers and networks for BVHS facilities, entities, service lines, physicians and midlevel providers to ensure enrollment and/or participation is approved by and loaded in payer plans or networks.

Duty 6: Creates, maintains and distributes timely, accurate and detailed databases for payer credentialing management (providers, participation status, submission dates, contracting process and status tracking, etc.), NPIs, W-9, tax IDs, provider numbers, etc. to ensure BVHS internal constituents have information needed to perform their jobs as relates to billing and managed care.

Duty 7: Works closely with Patient Revenue Cycle department to resolve global or systemic billing/payment issues related to provider enrollment and credentialing, payor system setup issues, etc.; acts as liaison between payer and Patient Revenue Cycle as needed to resolve issues.

Job Requirements

View Job at OMJ

18 total views

We are proud to offer priority of services to U.S. Military Veterans and eligible spouses.

Upcoming Events

View All News

Latest News

OhioMeansJobs Hancock is partnering with Findlay-Hancock County Economic Development to help employers find skilled workers for their job openings.

OhioMeansJobs- Hancock offers several free business development resources designed to help

Read More