Provider Enrollment Specialist
At SCP Health, what you do matters
As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.
Why you will love working here:
- Flexible schedules and work-from-home opportunities
- Strong track record of providing excellent work/life balance
- Comprehensive benefits package and competitive compensation
- Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.
What you’ll be doing:
The Provider Enrollment Specialist directly impacts the financial stability of the Company because he/she is the SCP Health representative who coordinates the provider number approval process. The Provider Enrollment Specialist, using his/her knowledge of SCP Health policies in conjunction with insurance carrier credentialing and enrollment requirements, facilitates provider enrollment and billing privileges on behalf of all SCP Health applicants through coordination of insurance plan enrollment and credentialing activities among various parties, including the Provider, Operations staff, Insurance Carrier and Billing Company Representatives.
- Process Medicare, Medicaid, BCBS and Managed Care (third party payors) applications simultaneous to hospital privileging process.
- Work directly with the Provider Enrollment Supervisor and the Team Lead processing Provider Enrollments and appeals in a timely manner.
- Assist Provider Enrollment Supervisor and Team Lead when needed in resolving payor related issues and disputes.
- Collaborate with PE, Managed Care, Systems/Billing and any other SCP departments to ensure the integrity of the revenue is preserved.
- Participate in any/all meetings related to Provider Enrollment as designated by the Supervisor and/or Team Lead.
- Provide insight where applicable to Billing Company on enrollment and claims related issues
- Follow-up with insurance plans to secure provider approval through provider number (PIN) assignment. Enter approval information into CredStream so billing company can be notified to release claims.
- Document and keep accurate account of all submissions, approvals and follow up information in CredStream.
- Work with SCP Managed Care to ensure timely enrollment with managed care plans to maximize reimbursement and minimize patient complaints related to participation status.
- Provider Enrollment Specialist has access to confidential and protected patient information and must handle sensitive information in accordance with SCP Health protocol and HIPAA rules and regulation.
- Monitor carrier website for forms revision and update master provider enrollment packets as needed
- Advise management of issues with payor plans and providers.
Who/What we are looking for:
- Minimum of 2 years of Credentialing or Enrollment experience is highly recommended.
- HS Diploma required. Some college preferred
- Requires agility in managing multiple priorities
- Knowledge of Payor Credentialing processes, both Par and Non-Par
- Knowledge of Provider Credentials
- Knowledge of CMS Regulations and guidelines
- Manage stress appropriately
- Overall working knowledge of software programs with a drive to incorporate technology in all operational functions
- Solid organizational skills
- Ability to foster a cooperative and respectful work environment.
- Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community
SCP Health and its affiliated companies require all applicants for a non-clinical position to be vaccinated against COVID-19 as a condition of employment, except where prohibited by state or local law. To demonstrate compliance with SCP Health’s vaccination policy, proof of COVID-19 vaccination status will be requested upon a conditional offer of employment. SCP Health will consider religious and/or medical/disability accommodation and other legally required exemption requests as required by applicable law.
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SCP Health is an Equal Opportunity Employer.