Provider Enrollment Coordinator

Children's Hospital of Philadelphia; Philadelphia (Philadelphia County); On-site; USD 35,000 - 44,000; Full time

Job summary

Children's Hospital of Philadelphia (CHOP) is seeking an experienced enrollment and credentialing coordinator to gather and verify healthcare practitioner information, ensure licensing and documentation are complete, and maintain provider records.

You will manage payers' enrollment and re-credentialing, monitor expirations, coordinate with Billing and Enrollment Managers, and keep CAQH/NAVINET/ECHO systems up to date to support timely reimbursements.

Qualifications

• Education and two years of insurance verification or billing experience required.
• Experience with payer enrollment or provider relations is required.
• Familiarity with CAQH, NAVINET and ECHO systems preferred.

Responsibilities

• Prepare new hire enrollment packets for accuracy and timely submission to payers.
• Maintain physician database and CAQH re-attestation every 120 days.
• Maintain files, scan credentials and monitor expiration dates.
• Initiate follow-up with payers to ensure timely provider participation dates and numbers.
• Support claims issue resolution by providing research to Billing.

Skills

Insurance verification

Billing processes

Provider relations

Medicare/Medicaid policies

MS Word/PowerPoint/Excel

CAQH NAVINET ECHO systems

Analytical thinking

Organizational skills

Collaboration with stakeholders

Education

High School Diploma / GED

Associate's Degree Preferred

Tools

CAQH

NAVINET

ECHO

MS Word

Excel

PowerPoint

Job description

Seeking Breakthrough Makers

Children’s Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.

SHIFT: Day (United States of America)

Seeking Breakthrough Makers

Children’s Hospital of Philadelphia (CHOP) offers countless ways to change lives. Our diverse community of more than 20,000 Breakthrough Makers will inspire you to pursue passions, develop expertise, and drive innovation.

At CHOP, your experience is valued; your voice is heard; and your contributions make a difference for patients and families. Join us as we build on our promise to advance pediatric care—and your career.

CHOP does not discriminate on the basis of race, color, sex, national origin, religion, or any other legally protected categories in any employment, training, or vendor decisions or programs. CHOP recognizes the critical importance of a workforce rich in varied backgrounds and experiences and engages in ongoing efforts to achieve that through equally varied and non-discriminatory means.

A Brief Overview

This role is responsible for gathering and verifying healthcare practitioner information and tracking all compliance information related to the enrollment and re-credentialing process. This includes processing all incoming applications to ensure accuracy at completion and that all required licensing and certification documentation is present, as well as all additional required documentation. All necessary file maintenance functions, including updating service locations, rendering provider information; licensure and ownership information is also a function of this position.

What You Will Do

• Provides reviews and prepares new hire enrollment packets for accuracy, completeness and timely submission to the payers and maintains current provider information in order to ensure timely reimbursement of payment for services. Performs follow-up with the physicians to request necessary documentation for the application/re-credentialing process (Renewal reminders must be sent 30 days prior to the expiration date).
• Maintains a working knowledge of payers’ processes and updates and ensures that the physician database and NPPES system is kept accurate and current. CAQH re-attestation to occur every 120 days for all providers.
• Maintains files, scans credentials and monitors expiration dates and notifies administrators and Enrollment Manager of deadlines.
• Initiates phone calls, generates letters and other correspondence as required for follow up with payers to ensure timely receipt of provider participation effective dates and numbers (goal is within 60 days of payer receipt date of the application). Assures that all contacts and discussion with payers are documented and maintained, as well as copies of emails and/or written correspondence sent to third party payers, for future reference.
• Reviews and provides research results to the Billing Department to assist with claims issue resolution.

Education Qualifications

• High School Diploma / GED Required
• Associate's Degree Preferred

Experience Qualifications

• At least two (2) years Previous experience with insurance verification, billing and/or provider relations Required or
• At least two (2) years medical insurance verification/provider relations. Required

Skills And Abilities

• Working knowledge of insurance billing/provider operations within a large healthcare organization. (Required proficiency)
• Knowledge of Medicare and Medicaid policies and procedures. (Required proficiency)
• Basic proficiency with MS Word, Power Point, Excel computer programs (Required proficiency)
• Knowledge of the ECHO, NAVINET and CAQH systems (Required proficiency)
• Solid critical thinking / problem-solving skills (Required proficiency)
• Solid analytical and organizational skills. (Required proficiency)
• Ability to collaborate with stakeholders at all levels (Required proficiency) To carry out its mission, CHOP is committed to supporting the health of our patients, families, and global community. As a condition of employment, CHOP employees who work in patient care buildings or who have patient facing responsibilities must receive an annual influenza vaccine. Learn more.

EEO / VEVRAA Federal Contractor | Tobacco Statement

SALARY RANGE:

$25.50 - $31.85 Hourly

Salary ranges are shown for full-time jobs. If you're working part-time, your pay will be adjusted accordingly.

At CHOP, we are committed to fair and transparent pay practices. Factors such as skills and experience could result in an offer above the salary range noted in this job posting. Click here for more information regarding CHOP's Compensation and Benefits.