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Payer Enrollment Coordinator

Saint Paul, Minnesota

Job ID: 9231 Category: Financial

Job Description

  • Maintains knowledge of, and complies with, all relevant laws, regulations and policies, procedures and standards
  • Actively participates in creating and implementing improvements to achieve clinical, satisfaction and/or efficiency outcomes
  • Informs payers and affected departments about new providers, changes in status such as changes in location, billing address, termination and addition of sites within established timeframes
  • Informs payers and our Client’s departments about new facilities, changes in status of facilities such as changes of address, billing address, closings, relocations, openings, mergers, and acquisitions within established timeframes.
  • Completes and returns payer requests for initial and recredentialing applications/paperwork for providers and business entities within established timeframes
  • Serves as the primary contact for payers and our Client’s departments regarding payer credentialing related issues
  • Partners/collaborates with hospital credentialing in order to facilitate payer credentialing needs
  • Researches and updates provider payer credentialing status's to support ACO activities and accurate data for reporting and analysis
  • Partners with patient accounting to monitor underpayments by ensuring accurate provider enrollment.  Keeps current with payer credentialing requirements and updates procedures as necessary        

 

Qualifications:

  • High school graduate or equivalent
  • 3 to 5 years payer credentialing experience, background in insurance contracting, billing and reimbursement preferred
  • Analytical Thinking: Ability to Identify issues, obtain relevant information, relate and compare data from different sources, and identify alternative solutions
  • Attention to Detail: Achieves thoroughness and accuracy when accomplishing a task
  • Computer Skills Basic: Ability to use a computer and applications that are associated with performing basic work tasks (use a mouse, navigate in Windows, Outlook, etc)
  • Decision Making: Makes timely, informed decisions that take into account the facts, goals, constraints and risks
  • Organization: Effective management of projects, deadlines, and work load prioritizing; putting things together in an orderly and functional whole
  • Problem Solving: Identifies problems; determines accuracy and relevance of information; utilizes appropriate tools and staff resources along with sound judgment to generate and evaluate alternatives, and to make recommendations
  • Team/Relationship Management: Partners with teams effectively to maximize performance, utilizing communication skills, facilitation skills, and knowledge of team dynamics and adapting to change        
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