Northern Light Health

Department: Credentialing

Position is located: Douglas Brown Building

Work Type: PRN (Pool/Per Diem)

Hours Per Week: Variable

Work Schedule: Variable

Summary :

The Provider Enrollment Specialist is responsible for the timely submission of provider enrollment applications to governmental and commercial payers and for performing the tracking and follow-up required until providers are established and linked to the appropriate group entity.

Responsibilities :

• Manage the successful completion and submission of provider enrollment applications
• Perform tracking and follow-up to ensure providers are established and linked to the appropriate group entity in a timely manner
• Understand specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation and regulations.
• Maintain documentation and reporting regarding provider enrollments in process
• Maintains provider enrollment files electronically via credentialing software, shared computer files and CAQH (Council for Affordable Quality Healthcare)
• Work closely with departments credentialing staff and member hospitals to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc.
• Ensure that established provider IDs and effective dates are communicated to appropriate billing and revenue departments so claims can be processed for submission
• Maintain provider enrollment information within the credentialing database
• Establish close working relationships within department and with various departments across system
• Processes and distributes appropriate correspondence
• Maintains working knowledge of applicable regulations, policies and procedures.
• Represents the office to internal and external customers as appropriate
• Performs miscellaneous job-related duties as assigned.

Other Information :

Competencies and Skills

• Behaves with Integrity and Builds Trust: Acts consistently in line with the core values, commitments and rules of conduct. Leads by example and tells the truth. Does what they say they will, when and how they say they will, or communicates an alternate plan.
• Cultivates Respect: Treats others fairly, embraces and values differences, and contributes to a culture of diversity, inclusion, empowerment and cooperation.
• Effectively Communicates: Listens, speaks and writes appropriately, using clear language. Communication methods are fitting to the message(s), audience, and situation and follow-ups are regular and timely. Shows that important (non-) verbal information is absorbed and understood and asks further questions to clarify when necessary. Expresses ideas and views clearly to others and has ability to adjust use of language to the audiences' level.
• Fosters Accountability: Creates and participates in a work environment where people hold themselves and others accountable for processes, results and behaviors. Takes appropriate ownership not only of successes but also mistakes and works to correct them in a timely manner. Demonstrates understanding that we all work as a team and the quality and timeliness of work impacts everyone involved.
• Practices Compassion: Exhibits genuine care for people and is available and ready to help; displays a deep awareness of and strong willingness to relieve the suffering of others.

Education

• Required High School Diploma/General Educational Development (GED)

Working Conditions

• Work beyond the regularly scheduled hours.
• Prolonged periods of sitting.
• Prolonged periods of standing.
• Prolonged periods of walking.