Provider Enrollment Coordinator II

Job Summary

Responsible for the enrollment process for all Geisinger Providers and third-party payers. Responsible for the facility enrollment for all Geisinger owned entities. Ensures appropriate provider and facility enrollment procedures and policies are in order to accurately and timely enroll providers and facilities with all payers while ensuring compliance with contractual, state, and federal regulations. Ensures proactive review and process change based on proposed/enacted regulatory changes.

Job Duties

• Provides completed enrollment documents to the providers after receiving notification from the Credentialing department, Clinical Operations, Coordinators, or any other means.
• Maintains a complete understanding of the items required for enrollment for each participating insurance plan.
• Prepares and submits government credentialing applications and supporting documentation for the purpose of enrolling and re-enrolling individual physicians and other healthcare practitioners with Medicare, Medicaid and other government payers
• Prepare and submit government payer re-credentialing applications as required by Medicare, Medicaid or other government payers
• Stay abreast of upcoming changes to forms; process, to ensure enrollments are completed correctly and in a timely manner.
• Provides day-to-day support and advice regarding enrollment.
• Provides feedback to other staff departments with regards to issues relating to enrollments.
• Responsible for identifying denial trends and working with teams to facilitate root cause analysis and continuous process improvement.
• Maintains an understanding of the third-party payor requirements.
• Coordinates providing monthly-managed care files to all the Third Party Payor in which Geisinger has a delegated credentialing agreement. Coordinate with regional managed care staff to ensure physicians and facilities and other health care providers are enrolled timely with contracted commercial payers.
• Provides follow-up with each payor on any enrollment issues that are a result of the monthly downloads.
• Work claim edit work queues and add provider identification numbers to Epic to ensure claims are released for payment
• The coordinator is a liaison that will be responsible to attend meetings with Operations, Rev Cycle, Legal, Quality Performance and Third-party payors to assist with opening new locations, onboarding of new services in the organization.
• Provides technical resources to the department regarding all billing systems responsibilities, such as claim form logic, referring provider dictionary, provider dictionary, billing area dictionary, location, specialty etc.
• Responsible for maintenance of all providers, referring physicians, billing areas, locations, and hospitals within the billing system(s).
• Ensures the National Practitioner Identification numbers are applied for on behalf of Geisinger and maintained with any needed updates
• Ensure the systems are updated appropriately.
• Updates Medicare, Medicaid and Third Party Payor and any changes.
• Updates and maintains CAQH practitioner accounts to ensure proper payer enrollment, including malpractice certificate updates
• Completes Enrollment for Third Party Payer Hospital Contract and Out of State Medical Assistance.
• Organizes and maintains enrollment files and information following confidentiality guidelines, performs varied clerical support functions.
• Internally audits and maintains physician files in accordance with established principles of legal documentation and confidentiality.
  
  

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

This posting reflects an opening for Provider Enrollment Coordinator level II and we are seeking candidates for that position. Geisinger reserves the right to consider applicants for level III based on their skills, qualifications, and experience. We encourage all qualified individuals to apply.

Position Details

Education

High School Diploma or Equivalent (GED)- (Required)

Experience

Minimum of 3 years-Related work experience (Required)

Certification(s) and License(s)

OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.