Payer Credentialing & Enrollment Specialist

Blanchard Valley Health System; Findlay (OH); On-site; USD 60,000 - 75,000; Full time

Job summary

Blanchard Valley Health System in Findlay, OH is seeking a Credentialing and Enrollment Specialist to coordinate government payers, commercial networks, and BVHS facilities. You will manage provider enrollment, credentialing, and data integrity to support timely billing and network participation.

Responsibilities include leading data analyses, contract coordination, and maintaining databases for contracts, NPIs, tax IDs, and payer contacts.

Qualifications

• Bachelor's degree in business or health-related field, or equivalent relevant experience.
• Excellent organization, time and work process management skills.
• Strong database management and analytical skills.
• Strong problem-solving skills and operation improvement orientation.
• Positive service-oriented interpersonal and communication skills.
• Demonstrated skills in using Excel, Word and Microsoft Access.

Responsibilities

• Leads operational projects and performs routine and special analyses and data collection projects for the Managed Care department to advance successful implementation of the managed care strategy.
• Conduct contract negotiations with specified payers. Leads contract implementation and renewal activities for all payers for BVHS entities and physicians.
• Creates, maintains and distributes timely, accurate and detailed databases for contract management (participation status, rates, contacts, renewals, contracting process tracking, etc.), NPIs, W-9, tax IDs, provider numbers, etc. to ensure BVHS constituents have information needed to perform their jobs as relates to billing and managed care.
• Manages and performs data management, reporting and analytic projects for various projects.
• Coordinates activities related to employer, provider and payers, including workshops, seminars, educational sessions, health promotion, etc. to promote BVHS services and ensure access to payer volume as well as to facilitate compliance with managed care contracts.
• Maintains current knowledge base regarding governmental and commercial payer enrollment and credentialing requirements. Collects, completes and coordinates submission of timely and accurate provider enrollment and certification applications and credentialing and recredentialing information to commercial and governmental payers for BVHS entities and physicians to ensure contracted status.
• Researches and intervenes to resolve systemic billing/payment issues with contracted payers related to provider enrollment and credentialing, payer system setup issues, etc. working in cooperation with patient Revenue Cycle.
• Provides administrative support activities as needed to the managed care dept.

Skills

Organization

Database management

Analytical skills

Problem solving

Excel/Word/Access

Education

Bachelor's degree in business or health-related field

Tools

Excel

Word

Microsoft Access

Job description

Blanchard Valley Health System in Findlay, OH is seeking a Credentialing and Enrollment Specialist to coordinate government payers, commercial networks, and BVHS facilities. You will manage provider enrollment, credentialing, and data integrity to support timely billing and network participation.

Responsibilities include leading data analyses, contract coordination, and maintaining databases for contracts, NPIs, tax IDs, and payer contacts.