Atrium Health Credentialing Enrollment Specialist Government Enrollment FT

Job Summary

Oversees the internal processes and procedures as well as Governmental, and regulatory requirements for the timely and accurate completion and submission of provider applications.

Assists in departmental planning, development, and organization.

Essential Functions

• Performs primary source verifications of documentation required for managed care credentialing and re-credentialing of MGD providers.
• Provides issue resolution and support regarding billing issues as they relate to provider enrollment and credentialing for MGD providers and the Central Billing Office.
• Enters provider data in the ECHO database according to established departmental processes and provides feedback to other System entities as to the status of the applicants.
• Performs follow-up on needed information (expired licenses, board certifications insurance and DEA registrations) on an ongoing basis and ensures receipt of same in a timely manner.
• Prepares physician files for file audits by managed care organizations, Corporate Compliance and accreditation entities.
• Conducts practice site visits for practices within MGD. Facilitates communication tools and or activities to maintain timely and accurate flow of information to Managed Care Organizations (MCOs) and the System.
• Reviews hard copy and electronic provider directories and other information produced by managed care organizations reflecting MGD and the System’s demographics and participation.
• Provides Team member support to the CPN Credentialing and Quality Review Committee.

Physical Requirements

Perform most duties under normal office conditions which may include sitting for long periods of time, standing, walking, using repetitive wrist / arm motion or lifting articles 20-50 pounds.

Work is subject to time sensitivity, heavy volumes, and frequent interruptions, either by phone or other employees. Must use frequent and variable body movements during filing and maintaining records.

Require frequent verbal and written communication in English to employees, corporate staff, providers, and external agencies.

Require occasional travel to other corporate offices. Use of personal vehicle required. Intact sense of sight and hearing required.

Education, Experience and Certifications

High school diploma or GED required; Bachelor's degree preferred. Three years’ experience in a role that performs or supports provider credentialing, privileging, and / or enrollment in either a hospital, managed care plan or CMS environment is required.

Knowledge of and experience with personal computers, Windows and Microsoft applications, copier and fax machines and multi-line telephone required.

Experience in typing, word processing, and business correspondence is required. Certification through National Association of Medical Staff Services (NAMSS) as Certified Provider Credential Specialist (CPCS) or Professional Medical Services Management (CPMSM) preferred.

Experience in credentialing or enrollment, payers claim denials and follow up is a plus.