Provider Enrollment Specialist

WVU Medicine; Bridgeport, Northern (WV, KY); On-site; USD 28,000 - 39,000; Full time

Job summary

West Virginia University Health System in Bridgeport, WV seeks a credentialing specialist to manage economic credentialing and enrollment for providers and facilities, ensuring active status with payers and governmental plans.

You will collaborate with leadership to maintain dashboards, monitor licenses, and generate standard reports that support revenue integrity and timely patient scheduling across multiple markets.

Qualifications

• High School Diploma or equivalent.
• Two years of health care industry experience.

Responsibilities

• In collaboration with hiring/onboarding personnel will serve as a concierge to guide the providers through the economic credentialing/enrollment and recredentialing/revalidation process. (managed care/Medicare/Medicaid/NPPES/I&A).
• Based on information from provider enrollment vendor, develops, maintains and monitors credentialing/enrollment database with applicable effective dates, to ensure an active status among contracted managed care payers, Medicare, Medicaid and other governmental plans.
• Ensures licenses and certifications are accurate and active among all markets.
• Tracks and monitors the return of registration packets and alerts hiring managers and/or recruiters of issues.
• Develops, manages, and utilizes a standard set of reports to track the registration process and communicate the status and successful enrollment to appropriate Vice Presidents, Administrators, Directors and Managers and billing units in an effort to manage the start date and prevent loss of revenue when possible.
• Regularly coordinates with IHS Vice Presidents, Administrators, Directors and Managers to obtain information for new facilities, practice locations, providers and services to be added under existing contracts for smooth revenue collection and contract compliance. This may require queries to the payers for strategic planning in advance of new services.
• Acts as an educational resource related to enrollment of facilities, practice locations and various provider types and is available for consultation to internal and external clients.
• Analyzes problems and draws accurate conclusions in regards to provider enrollment and credentialing issues. Proactively identifies and troubleshoots issues affecting provider payment. Then, resolves, provides recommended solutions, or forwards more complex issues onto appropriate person(s) for handling.
• Works collaboratively with Director of Professional Services, Manager, Professional Services, and Supervisor of Managed Care in regards to day-to-day operations and special projects.
• Maintains a high level of confidentiality in all aspects of the position.
• Must have a basic understanding of messenger model network and managed care contracting as related to the credentialing process.
• Must have a basic knowledge of credentialing policies, regulatory requirements and accreditation standards.

Skills

Analytical skills

Problem solving

Time management

Organizational skills

Microsoft Word/Excel/Access/Outlook

Education

High School Diploma

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

Microsoft Outlook

Job description

This position functions in a complex payer credentialing environment with changing health care rules, regulations and laws under the leadership of the Director of Professional Services. Responsible for the timely, efficient and accurate economic credentialing and provider enrollment of eligible West Virginia United Health System, WVU Health Sciences Eastern Division and WVU Health Sciences Charleston Division medical billing providers and facilities with contracted managed care and governmental plans. This position has continuous contact with internal and external customers including physicians, other healthcare providers, administrators, support staff and payor representatives. Additionally, this position is responsible for communicating provider participation information to stated internal and external customers through established processes to allow for appropriate patient scheduling and reimbursement for services rendered. Ensures compliance with regulatory agencies and maintains a working knowledge of statutes and laws that affect the credentialing/enrollment process. This position works collaboratively and gives support to the credentialing process.

MINIMUM QUALIFICATIONS

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• 1. High School Diploma or equivalent.

EXPERIENCE

• 1. Two (2) years of health care industry experience.

PREFERRED QUALIFICATIONS

• 1. Health care industry experience in professional billing, physician's office or credentialing preferred.

CORE DUTIES AND RESPONSIBILITIES

The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

• 1. In collaboration with hiring/onboarding personnel will serve as a concierge to guide the providers through the economic credentialing/enrollment and recredentialing/revalidation process. (managed care/Medicare/Medicaid/NPPES/I&A).
• 2. Based on information from provider enrollment vendor, develops, maintains and monitors credentialing/enrollment database with applicable effective dates, to ensure an active status among contracted managed care payers, Medicare, Medicaid and other governmental plans.
• 3. Ensures licenses and certifications are accurate and active among all markets.
• 4. Tracks and monitors the return of registration packets and alerts hiring managers and/or recruiters of issues.
• 5. Develops, manages, and utilizes a standard set of reports to track the registration process and communicate the status and successful enrollment to appropriate Vice Presidents, Administrators, Directors and Managers and billing units in an effort to manage the start date and prevent loss of revenue when possible.
• 6. Regularly coordinates with IHS Vice Presidents, Administrators, Directors and Managers to obtain information for new facilities, practice locations, providers and services to be added under existing contracts for smooth revenue collection and contract compliance. This may require queries to the payers for strategic planning in advance of new services.
• 7. Acts as an educational resource related to enrollment of facilities, practice locations and various provider types and is available for consultation to internal and external clients.
• 8. Analyzes problems and draws accurate conclusions in regards to provider enrollment and credentialing issues. Proactively identifies and troubleshoots issues affecting provider payment. Then, resolves, provides recommended solutions, or forwards more complex issues onto appropriate person(s) for handling.
• 9. Works collaboratively with Director of Professional Services, Manager, Professional Services, and Supervisor of Managed Care in regards to day-to-day operations and special projects.
• 10. Maintains a high level of confidentiality in all aspects of the position.
• 11. Must have a basic understanding of messenger model network and managed care contracting as related to the credentialing process.
• 12. Must have a basic knowledge of credentialing policies, regulatory requirements and accreditation standards.

PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORKING ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• 1. Standard office environment.

SKILLS AND ABILITIES

• 1. Strong analytical, problem-solving, time management, planning and organizational skills with excellent attention to detail and accuracy.
• 2. Ability to function independently with minimal supervision, in a demanding and fast paced environment.
• 3. Intermediate skill level in Microsoft Word, Excel, Access, Outlook.
• 4. Ability to establish and maintain effective working relationships with providers, staff, and other agencies; provide a positive service attitude when dealing with internal and external customers.

Additional Job Description

Scheduled Weekly Hours: 40 Shift: Exempt/Non-Exempt: United States of America (Non-Exempt) Company: SYSTEM West Virginia University Health System Cost Center: 649 SYSTEM Managed Care and Payer Relations Address: 1370 Johnson Ave Bridgeport West Virginia

Equal Opportunity Employer

Equal Opportunity Employer West Virginia University Health System and its subsidiaries (collectively "WVUHS") is an equal opportunity employer and complies with all applicable federal, state, and local fair employment practices laws. WVUHS strictly prohibits and does not tolerate discrimination against employees, applicants, or any other covered persons because of race, color, religion, creed, national origin or ancestry, ethnicity, sex (including gender, pregnancy, sexual orientation, and gender identity), age, physical or mental disability, citizenship, past, current, or prospective service in the uniformed services, genetic information, or any other characteristic protected under applicable federal, state, or local law. All WVUHS employees, other workers, and representatives are prohibited from engaging in unlawful discrimination. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, training, promotion, discipline, compensation, benefits, and termination of employment.

The West Virginia University Health System is West Virginia's largest health system and largest private employer, providing care to communities across West Virginia, Maryland, Ohio, and Pennsylvania. The integrated academic health system includes 25 hospitals and five institutes, with more than 3,500 licensed beds, 4,000 clinicians, 39,000 employees, and $8.5 billion in annual operating revenues. Anchoring the system in Morgantown, West Virginia, are WVU Hospitals, an 880-bed academic medical center, and the 150-bed WVU Medicine Golisano Children's Hospital. Together, the Health System's hospitals, clinics, and specialty programs provide a comprehensive continuum of care, ranging from community-based primary and specialty services to highly complex, quaternary care and post-acute care.