What are the responsibilities and job description for the Payer Enrollment Specialist Full Time position at Hughston?
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:
Required:
Required:
Special Qualifications:
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.
Required:
- One (1) year of credentialing or billing experience in a large medical clinic/hospital setting or in a payor setting.
- 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.
Required:
- High School Diploma or equivalent.
- Advanced degree in related field.
- PESC certification.
Special Qualifications:
- Valid Driver’s 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.