Sr medical staff provider enrollment coordinator - united states, oakland

summary

role overview

responsible for auditing and assisting medical staff provider enrollment coordinators throughout the initial and recurring enrollment process for internal and contracted healthcare providers with health plans including federal and state government agencies/programs and private healthcare insurers.

responsibilities

note: following are the duties performed by employees in this classification. however, employees may perform other related duties at an equivalent level. not all duties listed are necessarily performed by each individual in the classification. 

1.  monitors notifications of new providers and groups, changes, additions and terminations for completeness and accuracy.

2.  performs audits of initial, recurring, and termination workflows; identifies and communicates findings with teammates.

3.  assists with follow-up and escalated payer/provider related requests for additional information; responsible for investigation or follow-up of enrollment related denied claims work queue.

4.  gathers and provides all required applications, forms and supporting documents to provider enrollment.

5.  communicates credentialing and enrollment updates to the provider enrollment manager, markets, and senior leadership.

6.  provides reports as necessary for health plans, billing department, and payer relations department. 

7.  performs other duties as assigned.

qualifications

any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying.

required education: high school diploma or equivalent.

required experience: four years combination of medical staff services and/or health plan credentialing experience; provider enrollment experience with healthcare insurers. 

required licenses/certifications: provider enrollment specialty certificate (p.e.s.c.) from accredited agency.

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