What are the responsibilities and job description for the Payer Enrollment Specialist Full Time position at Hughston Clinic?
Position Goal
Maintain a proper understanding of payor credentialing requirements as well as Athena enrollment functions to ensure accuracy. Serve as primary contact for payor credentialing inquires.
Position Responsibilities:
- Complete and maintain all CAQH profiles for all providers including provider and location information.
- Complete and maintain payor directory portals (ex. Availity/LexisNexis/BetterDoc etc.) to ensure current/accurate information for all providers and locations.
- Maintain confidentiality of provider information.
- Monitor Athena Worklists to identify increases in accounts receivable or claims denials related to enrollment and credentialing issues and work towards resolution. Direct non-credential issues to appropriate departments.
- Respond to the Athena enrollment services Dashboard Tasks timely.
- Audit Athena Payer Enrollment Table to ensure accuracy.
- Audit claim holds in Athena to ensure credentialing tasks are accurate and update the enrollment table as necessary.
- Provide feedback for training related to patterns or identified rom erroneous claim items or scrubs found not to be credentialing/payor enrollment in nature.
- Payor enrollment enterprise liaison for queries and research.
Experience:
Required:
- One (1) year of credentialing or billing experience in a large medical clinic/hospital setting or in a payor setting.
Preferred:
- Three (3) years of credentialing or billing experience in a large medical clinic/hospital setting or in a payor setting.
Experience with the Athena platform.
Education:
Required:
- High School Diploma or equivalent.
Preferred:
- Advanced degree in related field.
- PESC certification.
Special Qualifications:
Required:
- Valid Drivers License and satisfactory motor vehicle record (MVR) may be required.
- Proficient in use of Microsoft Office (Excel/Word) and online insurance platforms.
- Must be able to prioritize work to meet deadlines despite frequent interruptions.
- Ability to work in a team environment.
- Must be able to prioritize tasks and use good professional judgment in assigned duties.
- Demonstrates exceptional critical thinking skills and the ability to extract pertinent information that is relevant to the role.
Must be able to prioritize tasks and use good professional judgment in assigned dutiesThe Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.
