Provider Enrollment Specialist / Managed Care / Full Time

Catawba Valley Health System; Conover (NC); On-site; USD 55,000 - 75,000; Full time

Job summary

Catawba Valley Medical Center is seeking a Provider Enrollment Specialist to manage enrollment and re-enrollment for providers with contracted payers and government programs. You will serve as a liaison to resolve credentialing issues and ensure timely submission of all applications with payer contacts and employed physicians.

The role requires a Bachelor's degree or equivalent experience in managed care or revenue cycle, and familiarity with CAQH, PECOS, and NCTracks.

Qualifications

• Bachelor's degree or 4 years' experience in managed care, credentialing, or revenue cycle.
• Advanced knowledge of all Microsoft Office products.
• One year of applicable experience. If candidate has no experience, they must have completed a successful healthcare or finance-oriented internship with good references or at least four years working in managed care, credentialing or revenue cycle.
• Experience in problem-solving, critical thinking, and accomplishing tasks on assigned timelines. Strong understanding of provider credentialing. Working knowledge of CAQH, PECOS and NCTracks. Ability to work independently.

Responsibilities

• Perform enrollment and re-enrollment functions for providers with contracted insurance carriers and government payers.
• Serve as a resource and liaison to implement and resolve issues related to enrollment credentialing.
• Work directly with payer contacts and employed physicians to ensure all applications are completed within specified time periods.

Skills

Problem-solving

Critical thinking

Independent work

Education

Bachelor's degree or 4 yrs experience in managed care/credentialing

Tools

CAQH

PECOS

NCTracks

Microsoft Office

Job description

Summary of Performance Expectations.

The primary function of a Provider Enrollment Specialist is to perform enrollment and re-enrollment related functions for providers with contracted insurance carriers and government payers, as needed. This position serves as a resource and liaison to implement and resolve issues related to enrollment credentialing. This position will work directly with our payer contacts as well as our employed physicians to ensure all applications are completed within specified time periods.

JOB DESCRIPTION

Summary of Performance Expectations.

The primary function of a Provider Enrollment Specialist is to perform enrollment and re-enrollment related functions for providers with contracted insurance carriers and government payers, as needed. This position serves as a resource and liaison to implement and resolve issues related to enrollment credentialing. This position will work directly with our payer contacts as well as our employed physicians to ensure all applications are completed within specified time periods.

Education And Credentials:

Required:

Bachelor's degree from an accredited college or a minimum of four years’ experience working in managed care, credentialing, or revenue cycle.

Preferred:

Advanced knowledge of all Microsoft office products

Work Experience:

Required:

One year of applicable experience. If candidate has no experience, they must have completed a successful healthcare or finance-oriented internship with good references or at least four years working in managed care, credentialing or revenue cycle.

Preferred:

Experience in problem-solving, critical thinking, and accomplishing tasks on assigned timelines. Strong understanding of provider credentialing. Working knowledge of CAQH, PECOS and NCTracks. Ability to work independently.

ABOUT US

About Catawba Valley Medical Center

COMPREHENSIVE, ACCESSIBLE HEALTHCARE SERVICES IN THE CATAWBA VALLEY

As the region’s largest not-for-profit community hospital, we exist to heal and comfort patients, to promote and foster a healthier community, and to ensure access to healthcare to all who need it - regardless of ability to pay. With a wide array of medical specialties, our skilled nurses and providers are trained to treat virtually any type of injury or illness, providing high-quality, easily accessible healthcare close to home.

Our mission: Exceptional Healthcare. Every Person. Every Time.

At A Glance:

• Region's only level III Neonatal Intensive Care Unit (NICU)
• Women's Choice Award winner for America's Best 100 Hospitals for Patient Experience for six consecutive years
• American College of Surgeons Accredited Comprehensive Community Cancer Center

HIGH LEVEL OF TECHNICAL CARE FROM MEDICAL EXPERTS

Catawba Valley Medical Center offers a wide range of services from experienced medical specialists capable of addressing virtually any healthcare concern. Our current hospital holds 258 beds and serves the five-county Hickory area. Through our skilled medical practitioners and our highly trained staff, we strive to provide the highest level of medical expertise using the latest, state-of-the-art technology available.

One of our goals at Catawba Valley Medical Center is to provide seamless care between your primary care provider and our hospital. Being a part of a vast healthcare network allows for easier and more efficient communication between local physicians, medical specialists and our hospital. No one should have to travel far for the expert level medical treatment they need. We work with a plethora of medical specialists capable of diagnosing, treating and operating on a wide variety of conditions.