Provider Enrollment Specialist - CAP

Centralus Health; Town of Ithaca (NY); Híbrido; USD 34.000 - 45.000; Jornada completa

Descripción de la vacante

The Provider Enrollment Specialist at Cayuga Health Partners Network supports enrollment and data maintenance to ensure network compliance with NCQA, CMS, and NYS DOH. You will build professional relationships with practices, providers, and payer representatives while ensuring timely enrollment and revalidation submissions.

This hybrid role in Ithaca, NY requires an Associate's degree and 2–5 years of provider enrollment or credentialing experience.

Formación

• Associate's degree required.
• 2-5 years of provider enrollment or credentialing experience in IPA/Medical Group/Hospital settings or healthcare operations.
• Notary Public certification preferred.

Responsabilidades

• Perform provider enrollment activities as necessary.
• Manage completion and submission of provider enrollment applications per payer requirements including documents (DEA, CV, etc.).
• Review enrollment documents for completeness (licensure, liability insurance, DEA).
• Follow up with physicians on missing information for enrollment.
• Generate and track provider revalidation applications and resolve delays with health plans and CHP participants.
• Update Provider Data Management System with new information.
• Coordinate with health plans to maintain Provider Rosters.

Conocimientos

Provider enrollment

Credentialing

Healthcare operations

Relationship management

Payer communications

Educación

Associate's degree

Herramientas

Provider Data Management System

Descripción del empleo

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. Interacts 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 in Ithaca, NY.

Pay Range Disclosure

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

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].