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System Payer Enrollment Specialist

Traverse City, MI

Website:
https://nlx.jobsyn.org/b74f8038f37a48f193c81780f0d140ab151

Posted on July 29, 2018

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About System Payer Enrollment Specialist

ENTRY REQUIREMENTS

  • Bachelor’s degree in health related field required, or equivalent experience.

  • Two years’ experience in payer enrollment, medical staff/physician services, hospital credentialing, or related field preferred.

  • Two years of medical billing experience with an understanding of Medicare, Medicaid, Health Maintenance Organizations and commercial insurance plans preferred.

  • Demonstrated working knowledge of Joint Commission standards, Medicare Conditions of Participation and other regulatory requirements with regard to compliance and health plan enrollment.

  • Proficiency with electronic information systems, data management, and research/verification/payer/credentialing processes.

  • Interpersonal skills to interact effectively with various levels of hospital/practice management staff. Ability to communicate and process highly confidential information and to exercise proper judgment and discretion in performing duties.

  • Strong written and verbal communication skills.

ORGANIZATION

  • This position reports to the Manager of System Credentialing.

  • Works closely with Munson Healthcare Medical Staff Offices and Central Billing Office.

  • Position is based out of the System Corporate Office.

AGE OF PATIENTS SERVED

No clinical contact with patients.

SPECIFIC DUTIES

  1. Supports the Mission, Vision, and Values of Munson Healthcare.

  2. Embraces and supports the True North philosophy of Munson Healthcare.

  3. Adheres to ESP House Rules and promotes personal and patient safety at all times.

  4. Acts as key point of contact for the processing of enrollment applications for all providers entering the Munson Healthcare System in an accurate, professional, timely manner and according to standards set by each health plan.

  5. Ability to exercise independent judgment within scope of knowledge and responsibility when working with payers, as well as key stakeholders and leaders throughout the Munson Healthcare organization.

  6. Works with System Credentialing and local medical staff contacts, as well as ambulatory practice staff and leadership to ensure accurate, complete and timely provider enrollment with all payers and sites.

  7. Communicate within internal departments and external sources with significant attention to detail, consistency, accuracy and preciseness.

  8. Responsible for completing the ongoing review and attestation of all Munson Healthcare provider enrollment records of all information garnered through investigation and follow up processes, maintaining HIPAA and regulatory compliance, while adhering to Joint Commission standards, CMS guidelines, and other regulatory bodies at all times.

  9. Ensures integrity of all databases and department systems by recording consistent and accurate information and facilitates sharing data with key stakeholders throughout the organization. Exhibits a thorough understanding of government, health plan and department guidelines, policies and procedures.

  10. Supports revenue cycle by ensuring thorough and timely enrollment is completed and communicated to all stakeholders.

  11. Acts as the primary contact for the central billing office when assistance is needed with claims issues and/or denial management.

  12. Supports healthcare team by supporting all physician services functions including recruitment, credentialing, payer enrollment, onboarding, data integrity, physician liaison, and provider relations/education.

  13. Performs other duties and responsibilities as assigned.

Job at a Glance

About Munson Medical Center

How to Apply