PROVIDER ENROLLMENT COORD, REVENUE CYCLE MEDICAL GROUP

Description

Location: SGMC Patient Financial Services
Department: REVENUE CYCLE MEDICAL GROUP
Schedule: Full Time, 8 HR Day Shift, 8-5

POSITION SUMMARY 

Responsible for initial and ongoing provider enrollment for: Medicare, Georgia Medicaid, Florida Medicaid, Blue Cross, Tricare, Commercial Payers (as required). Completes and maintains all credentialing and enrollment applications for contracted and employed providers, including physicians, physician assistants, nurse practitioners, licensed clinical social workers (LCSW), licensed professional counselors (LPC), licensed marriage and family therapists (LMFTs), psychiatrists, and dietitians. Completes and maintains all facility enrollment applications for SGMC Health, Inc, to include hospital services, ambulance services, ancillary services, sub-acute care services. Maintains all provider enrollment applications for all employed, and contracted medical providers of SGMC Health, Inc. and SGMC Physician Network, Inc. Participates in all management huddles and ongoing process improvement events for evaluation of quality and improvement. Escalates barriers that impede processes for timely enrollment with payers. Meet or exceed all deadline requirements for provider and communications, enrollment, and follow-up. Document, maintain, and crosscheck facility and provider credentials in multiple databases including CAQH and other third-party databases as required. Assists with the loading process of contracted health plans, including activities related to notification and provider enrollment issues. Monitors credentials such as Medical License, DEA, etc. to ensure they are active and in good standing at all time for provider enrollment re-certifications. Serves as the primary contact for providers and payors when questions regarding enrollment and re-enrollments. Maintains Provider Number Matrix, to include: National Provider Identifier (NPI) number, Medicare Provider ID, Georgia Medicaid Provider ID, Florida Medicaid Provider ID, Uniform Provider ID Number (UPIN), and License Number. Maintains Doctor Master File in hospital information system (HIS) to ensure all data is correct and current for billing purposes, including checking the National Practitioner Database for exclusion from Medicare for non-staff physicians. 

EDUCATION 

• Undergraduate degree in Business, Management or Finance is preferred. 
• Certified Patient Account Representative (CPAR), Certified Patient Accounts Manager (CPAM), Certified Public Accountant (CPA) preferred. 
• Certified Provider Enrollment Specialist Certification required. 

• Must have at least four years of progressive, related experience in provider enrollment and credentialing. 

• Working knowledge of Windows, Microsoft Office required. 
• Experience with utilizing general office equipment such as copier, fax, PC’s, and printers. 
• Knowledge of CMS Pecos platform. 
• Thorough knowledge of pertinent laws and regulatory requirements for provider enrollment. 

WORKING CONDITIONS - ADA INFORMATION 

Modern, well-lighted, air-conditioned, general office area. Moderate/High stress level. Incorporated within one or more of the previously mentioned essential functions of this position description is the following physical requirements: ability to sit, stand or walk for moderate periods; reading or printed material; listening to customers and staff; verbally responding to customers and staff; moderately heavy lifting {0-25lbs.}, reaching, stooping, pushing, pulling, bending, and twisting. Must be organized, self-motivated, and able to work independently of direct supervision to carry out responsibilities. Able to manage multiple priorities and meet deadlines.