Provider Enrollment Specialist
Eskenazi Health

Division:Eskenazi Health

Sub-Division:Hospital

Req ID:22026

Schedule:Full Time

Shift:Days

Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 333-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus including at a network of Eskenazi Health Center sites located throughout Indianapolis.

FLSA Status

Non-Exempt

Job Role Summary

The Provider Enrollment Specialist is responsible for all provider enrollments (including governmental and commercial plans), NPI maintenance for providers, creation of, and update of Cactus provider enrollment records, re-validation requests, and CAQH and u as well as all other enrollment related functions including review of and analysis of claim denials related to provider credentialing/enrollment The Provider Enrollment Specialist is responsible for understanding payor guidelines for enrollment for all contracted plans including governmental and commercial plans as well for collaborating with other PFS and EPIC team members to ensure timely reimbursement of claims and improved cash flow through reduction of denials and rejections related to credentialing and enrollment. The Provider Enrollment Specialist works with contracted payors, providers, and operational areas in order to ensure appropriate information is obtained to support accurate and timely enrollment of providers with all contracted payors/insurance plans.

Essential Functions and Responsibilities

Proactively contributes to Eskenazi Health's mission: Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County; models Eskenazi Health values.
Prepares and verifies applications for initial enrollment and re-enrollment within established time frames and in accordance with the standards required by Medicare, Medicaid and other third-party payers we are contracted with.
Identifies health care providers who need to update enrollments or re-validation, CAQH updates, NPI updates; prepares and mails packets, collects required information, verifies information, and completes appropriate follow-up to complete the application(s).
Maintains the practitioner database to ensure it is accurate and current in Cactus as well as internal checklists and provider files maintained on the shared drive and/or SharePoint site.
Communicates and follows up with new providers to ensure all enrollment paperwork is sent out and returned within established time frames. Notifies management if a provider is not responding.
Generates ad hoc reports from CACTUS or other internal dashboards/monitoring tools upon request.
Ensures timely notification of is provided to team members (and other departments within Eskenazi) when new providers will be joining, terminating and when enrollments are complete in order to support nThrive, EPIC, and Provider Relations.
Ensures timely submission of enrollment forms and supporting documentation on rosters, payor portals, etc. in order to ensure timely enrollment of new providers, terming providers and updates (including changes in provider demographic data such name, practice location and other data as required by payor contracts.
Ensures that enrollment workflow is updated to include new contracts/payors as new contracts are signed with payors.
Maintains proof of licensure renewals, professional liability coverage, collaborative agreements, and other required certifications.
Assists in assuring the integrity of the Eskenazi Health process. Assists in ensuring adequacy and coordination of information required to successfully meet applicable standards resulting in achievement of successful enrollment.
Develops and maintains health care provider files to meet hospital, regulatory, legal, and payer requirements.
Maintains knowledge of enrollment processes and requirements for Medicare, Medicaid and other third-party payers of Eskenazi Health to remain compliant.
Recommends changes to policies and processes to ensure compliance and timely completion of provider enrollments to management team.
Identifies areas for improvement in the enrollment process and recommends options for consideration to the management team.
Serves as information resource to health care providers and all of Eskenazi Health regarding enrollment status and processes with various payers.
Provides/edits necessary information to maintain/update current doctor master files in the various billing systems within Eskenazi Health.
Provides assistance with projects as requested by the management staff of Eskenazi Health.
Creates an electronic record of all enrollment files and documents within Cactus.
Assists with and supports delegated credentialing process for all carriers with whom there is an agreement.
Participates in peer quality audits to ensure consistency of the enrollment processes in alignment with departmental needs and external payor and governmental regulations

Job Requirements

• Associate's Degree in Business Administration or equivalent experience is required; Bachelor's Degree or equivalent experience preferred
• In lieu of degree must have a minimum of 3 years directly related work experience in this field
• 2-3 years of experience with healthcare provider enrollment and/or credentialing
• Cactus experience a plus

Knowledge, Skills & Abilities

• Computer skills to include database, word processing, spreadsheet, and use of internet services
• Presents a professional image and cooperative attitude to multiple groups
• Excellent communication skills - verbal (both face-to-face and telephone) and written
• Ability to provide guidance and feedback in a positive and professional manner
• Excellent organizational skills and attention to detail
• Ability to prioritize and coordinate completion of a number of activities/projects simultaneously
• Ability to work independently and with minimal supervision
• Ability to work effectively in a team environment
• Ability to complete work during high-pressure periods while maintaining flexibility and a pleasant attitude

Accredited by The Joint Commission and named as one of Indiana's best employers by Forbes magazine for two consecutive years and the top hospital in the state for community benefit by the Lown Institute, Eskenazi Health's programs have received national recognition while also offering new health care opportunities to the local community. As the sponsoring hospital for Indianapolis Emergency Medical Services, the city's primary EMS provider, Eskenazi Health is also home to the first adult Level I trauma center in Indiana, the only verified adult burn center in Indiana and Sandra Eskenazi Mental Health Center, the first community mental health center in Indiana, just to name a few.

Nearest Major Market: Indianapolis

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