Quality Assurance Specialist - Payor Enrollment Team
symplr

Job Info

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Overview

The symplr Quality Assurance Specialist performs a critical role in auditing all phases of provider enrollment on behalf of medical providers with commercial and/or government payers.

Duties & Responsibilities

• Audit data entry, CAQH, follow up logs/calls, enrollment applications, link letters and spreadsheets for accuracy and completeness based on internally documented standards and payer standards.
• Provide feedback to our enrollment team managers in a courteous and confidential manner.
• Maintain necessary logs, lists, records, and current documentation required for internal audits.
• Provide routine follow up and status confirmation of audits pending corrections.
• During auditing, identify and record trends to contribute to process improvement efforts in both quality and efficiency.
• Maintain relationships with payer representatives and clients as required.
• Respond to all external/internal inquiries in a timely manner.
• Participate in team meetings and process improvement initiatives to continuously improve work product quality and efficiency.
• Performs other duties as assigned.

Skills Required

• Highly self-motivated, preferably with some expertise with payer enrollment process for all levels of licensure including but not limited to MD/DO, NP, PhD, PT, OT, LCSW, OD, DDS, DPM, etc. across all specialties including medical, dental, vision, behavioral health, and physical health.
• Success-driven and results-oriented, with the ability to implement and manage cross-functional projects
• Proficiency with credentialing systems and learns new systems/processes quickly
• Familiarity using payer websites including but not limited to CAQH, Pecos, NPI/NPPES, Availity, Navinet, CMS I&A
• Ability to interact effectively with a variety of people (such as physicians, medical staff offices and Health plans)
• Provides highest level of customer service for both internal and external customers
• Strong written and verbal communication skills, along with strong presentation and client interaction skills
• Ability to prioritize tasks and projects.
• Accurate discernment on when to act independently and when to ask for guidance and/or assistance
• Consistently demonstrates flexibility, a customer-focus, terrific organizational skills and a passion for details

Qualifications Required:

Every organization has a culture, whether they mean to or not, so why not be intentional about it?

Together, if we shape our intentions, actions, and interactions around a common, purposeful culture, we are able to quickly achieve more, attract others who help realize our goals, and thrive in our professional relationships.

• Associate degree or an equivalent combination of education and/or experience in healthcare
• 3+ years of Payor Enrollment Experience.
• Preferred experience in managed care, provider credentialing, patient financial services or provider relations
• Prior data management/data integrity experience preferred

Min
USD $22.00/Hr.
Max
USD $25.00/Hr.

This job has expired.