Provider Enrollment Specialist - CAP

CH_050 Cayuga Medical Center at Ithaca, Inc.; Hayts Corner (NY); Hybrid; USD 34,000 - 45,000; Full time

Job summary

The Provider Enrollment Specialist at Cayuga Health is responsible for the initial and ongoing maintenance of provider and organization data, and for completing enrollment applications per internal policies and payer requirements to ensure network compliance. The role acts as a liaison among the Cayuga Health Partners Network, Centralus Health, providers and plans.

The role also builds relationships with practice billing/credentialing staff and payer representatives, supporting timely enrollment

Qualifications

• Associate's degree required.
• 2-5 years of provider enrollment or credentialing experience.
• Licensure not required.

Responsibilities

• Perform provider enrollment activities as necessary.
• Manage completion and submission of enrollment applications for CHP providers.
• Understand payer requirements and required forms and documentation.
• Verify information on enrollment documents, including licensure and insurance.
• Follow up with physicians/providers on missing enrollment details.
• Maintain Provider Data Management System and provider rosters.

Skills

Enrollment experience

Credentialing experience

Notary Public certification

Education

Associate's degree

Job description

About Cayuga Health

Cayuga Health offers patient-centered, comprehensive health services at Cayuga Medical Center in Ithaca; Schuyler Hospital in Montour Falls; and more than 40 medical offices in the Finger Lakes and Central New York. Cayuga Health employs more than 450 providers from 40+ specialties. Additional services include a neo-natal intensive care unit, a home health care agency, an addiction recovery organization, and a skilled nursing facility. Cayuga Health is a member of Centralus Health, a community-based integrated delivery system. Our mission is to deliver high-quality care, empower our teams to succeed, and improve the wellbeing of the communities we serve. Our commitment to quality personalized care begins with our exceptional team—over 6500 employees strong. At Cayuga Health, you will work in a collaborative environment that values excellence, integrity, compassion and stewardship. Together, we create an environment where empathy, honesty and a dedication to quality thrive, empowering us to make a positive impact on the lives we touch. We offer competitive wages, comprehensive benefits, and professional development opportunities to help our employees grow and thrive. Whether you are just starting your career or taking the next step in healthcare, we invite you to join us in shaping the future of care in our communities. Learn more at www.cayugahealth.org.

Summary

The Provider Enrollment Specialist is primarily responsible for the initial and ongoing maintenance of provider and organization data entry and enrollment needed to support multiple functions within the Cayuga Health Partners Network and Centralus Health. This position will be responsible for completing provider enrollment applications according to internal policies, health plan policies, and other regulatory agencies such as NCQA, CMS, and NYS Department of Health, ensuring continued Network compliance. This position acts as a liaison between our Network, CHP providers and practices, and health plans. The Provider Enrollment Specialist will build and maintain professional relationships with Practice billing and credentialing staff, payer-provider representatives, and providers.

Roles and Responsibilities

• Perform provider enrollment activities as necessary.


• Manage the completion and submission of provider enrollment applications for CHP providers according to plan specifications.


• Understand specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.) and regulations.


• Review and assess for completeness of information of enrollment documents, including current state licensure, liability insurance, DEA, etc.


• Responsible for follow-up with physicians and providers on missing information needed to complete payer enrollment.


• Responsible for the generating, mailing, tracking, and subsequent processing of provider revalidation applications.


• Interact with representatives from health plans in an effort to resolve any delays in approvals as well as CHP participants to answer inquiries and clarify requirements.


• Update Provider Data Management System when new information is received.


• Responsible for working with health plans on a routine basis to maintain their Provider Rosters.


• Responsible for notification to health plan and applicable CHP participants.


• Notification includes date of contract termination, anticipated health plan termination (if different than contract termination) and provider for membership re-assignment.


• Maintain a current and accurate Provider Roster, communicating provider changes to appropriate CHP staff to support Network Initiatives.


• Maintains extensive working knowledge of provider enrollment.


• Is flexible in assuming other appropriate responsibilities not noted above.

Required Skills and Experience

Education - Associate's degree

Experience - Two to five (2-5) years of experience, including previous provider enrollment or credentialing experience with IPA / Medical Group / Hospital experience or healthcare operations experience (i.e. claims processing, billing, provider relations or contracting)

Licensure - None required

Preferred Skills and Experience

Notary Public certification

Physical Requirements

90% sitting; 10% standing Must be able to remain at a workstation and move around the workspace as needed to complete job tasks, with or without reasonable accommodation. This position may require occasional driving to practice locations. The person in this position frequently communicates with Practices and Providers. Must be able to exchange accurate information in these situations.

Location, Travel and Shift Requirements

Hybrid position available. Preferred one to two days per week in the office as needed.

Pay Range Disclosure

Standard Rate of $25.00 - $33.00 per hour plus benefits

EEO / DEI / Diversity Statement

Centralus and its affiliates are committed to treating all patients, providers, staff and volunteers equitably and with dignity, ensuring the highest levels of safety, care and respect, and striving to recognize and overcome biases and policies that contribute to disparities in healthcare access, equitable care and positive health outcomes for all.

We are proud to be an Equal Employment Opportunity employer, supporting the growth and health of our employees and community by embracing the rich diversity, needs and circumstances of all peoples and prioritizing opportunities to build a diverse and inclusive workplace.

We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable protected characteristics.

If you require reasonable accommodation to complete a job application, pre-employment testing, a job interview or to otherwise participate in the hiring process, please contact the Centralus Talent Acquisition team at [e-mail].

Culture and Values

We're excited you're considering joining our team. At Centralus Health, we foster a culture of care, trust, and belonging. Here, you’ll have the opportunity to grow and thrive in your career while making meaningful connections with patients, families, colleagues, and communities.