Provider Enrollment & Network Compliance Specialist

Cayuga Health, A Member of Centralus Health; Town of Ithaca (NY); Hybride; USD 60 000 - 80 000; Plein temps

Résumé du poste

Cayuga Health Partners - Clinical Integration is seeking a Provider Enrollment Specialist to support initial and ongoing enrollment of providers and organizations. The role requires building relationships with CHP providers, practices, and health plans while ensuring enrollment activities align with internal policies and external regulations.

The position involves ensuring data accuracy, managing provider rosters, and coordinating revalidations, with a hybrid work setup and some in-office days.

Qualifications

• Associate degree required.
• 2-5 years of provider enrollment or credentialing experience (IPA/Medical Group/Hospital) preferred.
• Notary Public certification preferred

Responsabilités

• Perform provider enrollment activities as necessary.
• Manage the completion and submission of provider enrollment applications for CHP providers according to plan specifications.
• Review and assess for completeness of enrollment documents (licensure, liability insurance, DEA, etc.).
• Follow up with physicians and providers on missing information to complete payer enrollment.
• Generate, mail, track, and process provider revalidation applications; liaise with health plans to resolve delays.
• Update Provider Data Management System as information is received.
• Maintain Provider Rosters with health plans and CHP participants; notify of contract terminations and re-assignments.
• Maintain a current and accurate Provider Roster and communicate changes to CHP staff.
• Maintain extensive working knowledge of provider enrollment and take on additional responsibilities as needed.

Formation

Associate's degree

Description du poste

Cayuga Health Partners - Clinical Integration is seeking a Provider Enrollment Specialist to support initial and ongoing enrollment of providers and organizations. The role requires building relationships with CHP providers, practices, and health plans while ensuring enrollment activities align with internal policies and external regulations.

The position involves ensuring data accuracy, managing provider rosters, and coordinating revalidations, with a hybrid work setup and some in-office days.