POSITION TITLE: Provider Enrollment Coordinator

REPORTS TO: Manager of Credentialing

DEPARTMENT: Credentialing

SUPERVISES: None

EXEMPT / NONEXEMPT: Non-exempt

JOB SUMMARY: 

To perform and ensure the quality and timeliness of provider enrollment functions and to meet department and company objectives. Help to ensure adherence to contracts, internal Policies and Procedures, and NCQA Accreditation Standards.

PRIMARY REPONSIBILITIES

·       Perform provider enrollment functions, including but not limited to: CAQH on line application system (OAS), data entry into ULP Services internal credentialing system, NPI application, preparing and printing enrollment applications for government payors such as Medicare and Medicaid, enrollment activities for managed care payors, preparing and printing hospital, Kentucky license and DEA applications, and coordinate with the University groups/clinics to obtain necessary signatures for the applications.

·       Follow-up and tracking of provider enrollment applications and communication of status to the University groups/clinics.

·       Upon receipt of the ID numbers, notify the University groups/clinics.

·       Update credentialing database and CAQH as necessary to reflect accurate and current information.

·       Complete, count, and prepare regular provider enrollment status reports for distribution in house and external to the University groups/clinics.

·       Complete CAQH reattestation tasks for University Louisville Physicians practitioners.

·       Respond to practitioner, office staff, and other telephone or faxed requests. Document and assist in resolving practitioner/office issues involving provider enrollment.

·       Assist in development of department documents, forms, policies and procedures.

·       Oversee the processing of the Credentials incoming mail for date stamping, distribution, and correspondence requiring immediate response / action.

·       Responsible for requests and data entry updates for DEA, state license copy, and malpractice coverage updates.

·       Faxing, copying, mailing, and stuffing envelopes as needed.

·       Other duties as assigned by the Manager of Credentialing, to assure compliance with established policies and procedures in the Department.

JOB RESPONSIBILITIES:

·       High school degree / equivalent.  College degree preferred.

·       At least 2-3 years in Credentialing, Managed Care, Billing, or related field.

·       Knowledge of provider enrollment and billing.

·       Knowledge of NCQA standards. 

·       Exceptional organizational skills and attention to detail.

·       Extensive knowledge of Windows, Word, Excel, and Internet applications.

·       CPCS or CPMSM Certification as soon as eligible.

·       Must have initiative and be able to work independently.

·       Must be able to communicate effectively and professionally with private, state and federal agencies, as well as practitioners and clients, in order to investigate, collect information, and resolve issues.

·       Must be able to effectively and professionally interact and communicate with all associates as needed concerning credentialing issues.

Physical Demands / Work Environment

·       Works in well lighted/ventilated office area.

·       Is subject to interruptions.

·       Extended periods of time in a seated position.

·       Lifting (up to 20 pounds), bending, stooping.

·       Overtime may occasionally be required.

·       Must be able to communicate via spoken and written word, proficiently in English.

HOW TO APPLY

Click the following link to respond to the questionnaire and submit your resume and cover letter.  https://home.eease.adp.com/recruit/?id=1198371

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