Credentialing and Payer Enrollment Specialist

ABOUT US: Independent Physician Management (IPM) is a Managed Services Organization owned byOakLeaf Medical Network, an Independent Physician Association (IPA) and Clinically Integrated Network (CIN) serving physician and non-physician provider practices in Eau Claire and the greater Chippewa Valley. To support the mission and vision of OakLeaf Medical Network, IPM offers a comprehensive solution forHealthcare Payer Contracting, Credentialing, and Business Office Support.

JOB SUMMARY: The Credentialing and Payer Enrollment Specialist provides critical support to Independent Medical Practices within the OakLeaf Medical Network and beyond. This person supports all aspects of the payer enrollment process providing oversight and management of all related activities including confidential provider database administration, delegated credentialing enrollment activities to include roster management and reporting, ongoing monitoring of directory information for practices, and payer claims assistance for providers. This position also supports the reimbursement contract renewal lifecycle and actively takes charge of problems or projects working directly with all Healthcare Payers and or Independent Medical Practices.

Essential Functions

· Maintain confidential enrollment files in electronic credentialing database.

· Review credentialing files for accuracy and completeness.

· Monitor status of payer credentialing applications and perform follow-up as necessary.

· Assist with development of provider rosters to comply with various contracting services and requirements.

· Prepare and submit credentialing applications to payers on behalf of providers.

· Administer and oversee new and renewed enrollment processes for providers to ensure proper claim payment.

· Monitor and assist further investigations as deemed necessary by intervening to ensure that providers receive prompt and accurate reimbursement.

· Assist with development and completion of all quarterly and annual reports.

· Communicate payment, policy, or procedural information from the payors to member clinics.

· Facilitate the timely enrollment of new clinics and new providers.

· Serve as liaison between OLMN clinics and payer representatives to resolve all provider enrollment and payment-related issues.

· Initiate, receive, and resolve questions pertaining to enrollment and contract payment via phone and written correspondence.

· Special projects, as needed.

Qualifications Education

· High school graduate or GED equivalent.

· Bachelor's Degree preferred, preferably in Health or Business-related field, or a related combo of work and school.

Prior Related Experience

· A minimum of 3 years in health care with credentialing and payer enrollment processes.

· Experience and/or certification in MD Staff.

· Certified Payer Enrollment Specialist (CPES) preferred or willingness to obtain in 1st year of employment.

Eligibility

· The candidate must not have been sanctioned or excluded from participation in federal or state healthcare programs by a federal or state law enforcement, regulatory or licensing agency.

Knowledge, Skills and Abilities

· Effective and strong oral and written communication skills.

· A high degree of proficiency with Microsoft Office, including Excel, is a must.

· Ability to meet scheduled deadlines with minimal supervision.

· Ability to maintain professional demeanor and strict confidentiality of provider and company information.

· Maintain knowledge of NCQA, CMS, State and Federal regulations related to credentialing activities.

· Ability to multi-task, deal with complexity frequently, and have a strong tolerance for adaptability.

· Must be results-focused with the ability to effectively organize work, prioritize projects, and manage time.

· Rigorous attention to detail, data integrity, and accuracy is imperative.

· Be highly organized with record-keeping skills.

· Exercise strong judgment to analyze and interpret guidelines; assess, evaluate, and solve problems; and make recommendations for handling specific situations and creating more efficient workflows.

· A willingness to provide highly professional customer service, including a positive mental attitude, a willingness to collaborate, inherent resourcefulness and drive, and an ability to work independently is critical.

· Ability to work with a variety of people and circumstances.

Job Type: Full-time

Pay: $26.00 - $33.00 per hour

Work Location: In person

Salary : $26 - $33