Provider Enrollment Coordinator

Intermountain Healthcare Inc.; Audubon (GA); On-site; USD 65,000 - 90,000; Full time

Job summary

Intermountain Healthcare Inc. seeks a Credentialing Coordinator to act as a liaison among Medical Staff, Directors, and Administration, overseeing credentialing, privileging, and related administrative tasks.

The role ensures timely enrollment with commercial and government payers, maintains enrollment data, and supports communications across departments in a fast-paced healthcare setting.

Qualifications

• High School diploma or equivalent.
• One year experience in a healthcare revenue cycle setting.
• Knowledge of medical billing database work queues.

Responsibilities

• Coordinate enrollment and re-enrollment for providers across markets.
• Maintain detailed enrollment progress notes and distribute to stakeholders.
• Follow up with payers to monitor status of applications.
• Prepare and submit provider enrollment documents via portals.
• Collaborate with AR and Coding to identify denial trends.
• Support CAQH applications and provider changes with health plans.
• Ensure timely and accurate enrollment for government and commercial payers.
• Participate in enrollment progress meetings and communicate updates to leadership.
• Assist with onboarding/offboarding of providers in acquisitions.
• Maintain accuracy of payer enrollment data in the database.
• Engage with recruitment for onboarding processes.

Skills

Communication

Organizational Skills

Attention to Detail

Microsoft Office

Medical terminology

Customer Service

Tools

Healthcare billing databases

Job description

Job Description:

Provides ongoing support and coordination as a liaison between the Medical Staff, Medical Directors, and Administration. The position directs the on-going credentialing / privileging process and other administrative functions for the Medical Staff, Medical Director, Administration, and Allied Health Professionals.

Essential Functions

• Participates in enrollment progress update meetings for assigned market.
• Provides status information to stakeholders.
• Keeps detailed notes about enrollment progress in provider enrollment database and distributes information to designated department representatives and credentialing administrators.
• Completes all payer re-credentialing requests and demographic/roster requests.
• Completes out-of-State Medicaid individual and facility enrollments timely and accurately for assigned States.
• Participates in team work sessions for each market to address Epic hold and denial work queues and communicate issues and trends to leadership.
• Collaborates with AR to identify claim denial trends and with Coding to identify trend denials related to CPT codes and specific payer types.
• Coordinates all aspects of provider enrollment with commercial and government (Medicare and Medicaid) professional fee payer contracts for an entire market.
• Ensures enrollment is completed timely and accurately.
• Follows-up with managed care organizations and government payers to ensure timely and accurate enrollment.

Skills

• Computer literacy
• Microsoft Office
• Communication (oral and written)
• Organizational Skills
• Attention to Detail
• Accountability/ability to work independently
• Customer Service
• Knowledge of medical billing and collections
• Medical terminology

Job Essentials

1. 1. Responsible for ensuring timely and accurate facility, medical group, and individual government enrollments for technical and professional fee claim reimbursement.
2. 2. Coordinates all aspects of provider enrollment with Intermountain Health's commercial and government (Medicare and Medicaid) professional fee payer contracts for an entire market. Ensures enrollment is completed timely and accurately.
3. 3. Works in all phases of provider enrollment, re-enrollment and expirables management ensuring the timely and accurate enrollment (and recredentialing) of providers in commercial and government payers.
4. 4. Accurate data entry of up to date expirables, practice/billing locations and other pertinent information to the payer enrollment database.
5. 5. Participate in review, completion and/or submission of provider enrollment initial and re-enrollment applications for local and national commercial, Medicare, and Medicaid payers via payer online portals or other methods as applicable.
6. 6. Follow up with payers via phone, website, or email requesting network participation and follow up on submitted applications.
7. 7. Assist providers, and client personnel with completion of the application, routinely follow up with insurance carriers to monitor the status of applications and resolve issues.
8. 8. Facilitate completion, set-up and/or re-attestations of CAQH applications.
9. 9. Participates in enrollment progress update meetings for assigned market. Provides status information to stakeholders. Keeps detailed notes about enrollment progress in provider enrollment database and distributes information to designated department representatives and credentialing administrators.
10. 10. Submits provider change and termination requests to all health plans in a timely manner. Informs commercial and government payers and internal Intermountain stakeholders of provider and clinic updates in assigned market.
11. 11. Collaborates with AR to identify claim denial trends and with Coding to identify trend denials related to CPT codes and specific payer types.
12. 12. Execute large enrollment provider/payer projects. Complete provider enrollment and related duties for organizational clinic acquisitions. Collaborates with Recruitment in the onboarding and off-boarding of providers.

Minimum Requirements

• High School Diploma or Equivalent
• One year experience in a healthcare revenue cycle setting.

Preferred Qualifications

• One year of experience working with governments payers and/or commercial payers in a revenue service setting.
• Demonstrated knowledge of working medical billing database work queues.

Qualifications

• High School graduate or equivalent is required
• One (1) year previous work experience in healthcare
• Preferred previous work experience in a revenue cycle setting
• Preferred previous work experience with provider enrollment and/ or credentialing

Physical Requirements

Ongoing need for employee to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs.
Frequent interactions verbally and written with providers, colleagues and leadership
Frequent computer use for typing, accessing needed information, etc.
Manual dexterity of hands and fingers.

Location:

Lake Park Building

Work City:

West Valley City

Work State:

Uta