Provider Enrollment Specialist - PRN
Eskenazi Health

Job Info

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Division:Eskenazi Health

Sub-Division:Hospital

Req ID:10047

Schedule:PRN/Per Diem

Shift:Varied

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 327-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus as well as at 10 Eskenazi Health Center sites located throughout Indianapolis.

FLSA Status

Non-Exempt

Job Role Summary

The Provider Enrollment Specialist is responsible for all provider insurance carrier enrollments, NPI, Cactus, re-validation requests, CAQH, delegated credentialing and updating Cactus for both the provider and facility. The Enrollment Specialist reports to the Manager, Professional Services Billing.

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. 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 upon request.
• Notifies appropriate team members and insurance carriers when new providers will be joining, terminating and when enrollments are complete.
• 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.
• Performs delegated credentialing process for all carriers with whom there is an agreement.

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 one of the nation's 150 best places to work by Becker's Hospital Review for four consecutive years and Forbes list of best places to work for women, and Forbes list of America's best midsize employers' 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, the first community mental health center in Indiana and the Eskenazi Health Center Primary Care - Center of Excellence in Women's Health, just to name a few.

Nearest Major Market: Indianapolis

This job has expired.