Provider Enrollment Coordinator

Presbyterian is seeking a Provider Enrollment Coordinator to process health plan payer provider enrollment applications for all PHS system-wide employed or contracted healthcare providers as needed. Along with the Provider Enrollment Manager, directs the PHS system wide provider enrollment process to assure the ability to bill for all employed, contracted health care providers for whom PHS has accepted responsibility. Generates, processes, and assures completion of provider enrollment applications with various health plans with which PHS is contracted in order to assure the ability to bill for provider services. Directs the enrollment process for employed, contracted health care providers and any others as identified by management. Keeps in contact with providers by phone, email or mail to update them as their enrollment progresses.

Generates initial application, compiles necessary related documents, obtains all necessary signatures, and assures delivery of application to health plan payers. Obtains PIN s/enrollment numbers and communicates them to applicable billing office. Strives to maintain and ensure a strong positive working relationship with Medical Staff Affairs, Credentialing Verification Office, Business Office, Contracting personnel, as well as PMG and regional administrators. Good communication and working relationship with external agencies to assure optimum sharing of information and maximization of revenue through timely enrollment.

This is a Full Time position - Exempt: No
• Job is based at Rev Hugh Cooper Admin Center
• Work hours: Days

Ideal Candidate:

Experience in medical, business or medical staff affairs required.

• Associates Degree preferred or at least three (3) years of experience in a medical, business or medical staff affairs office required.
• Possess strong interpersonal skills and able to relate positively to health care providers.
• Possess basic computer skills including use of Windows, MS Office and Outlook.
• Claims processing and medical terminology experience a plus

Education Essential: High School Diploma or GED

• Assist with providing consultative support for all PMG providers and sites in regards to provider enrollment processes, licensing agencies and payers.
• Assist department manager with delegated payer annual/quarterly or monthly audits of the Presbyterian Health Plan credentialing files.
• Maintains provider enrollment files in accordance with health plan NCQA requirements and principles of confidentiality.
• Maintains ongoing positive interactions and employs public relation skills with the Provider Navigator and Medical Staff Affairs, Presbyterian Health Plan and Credentialing Verification Office credentialing personnel.
• Process all provider changes, (i.e. pointage, specialty, function, terminations etc.) with payers and complete any necessary applications to reflect a change in pointage or function.
• Performs audits of the credentialing database utilizing Cactus error reports, weekly change reports and weekly term reports from risk management as well as any reports from payers.
• Responsible for ensuring the monthly upkeep and uploading of the Provider Directory, credentialing grid and new provider status reports on the PEL.
• Assists in educating and training new staff within the department in regards to internal departmental desktop procedures and policies.
• Assist in developing and revising the departments credentialing and enrollment policies and procedures, criteria and audit tools and desktop manual to ensure accurate and consistent processing of provider applications.
• Performs denial management activities for their assigned providers using weekly/monthly write-off reports, Medicare and Medicaid denial reports and denial issues brought to the team from other departments.
• Responsible for purging of termed provider files from storage and getting any newly termed provider files prepped to be scanned.
• Handle all incoming customer complaints from EWC in regards to your assigned providers. Responsible for reviewing and conducting detailed investigative research into the matter, in a timely matter to better serve PHS members.
• Serve as the department representative/point of contact for contracted payer meetings.
  
  

About Presbyterian Healthcare Services
Presbyterian offers a comprehensive benefits package to eligible employees, including medical, dental, vision, disability coverage, life insurance, and optional voluntary benefits.

The Employee Wellness Rewards Program encourages staff to engage in health-enhancing activities - like challenges, webinars, and screenings - with opportunities to earn gift to earn gift cards and other incentives.

As a mission-driven organization, Presbyterian is deeply committed to improving community health across New Mexico through initiatives like growers' markets and local partnerships. Founded in 1908, Presbyterian is a locally owned, not-for-profit healthcare system with nine hospitals, a statewide health plan, and a growing multi-specialty medical group. With nearly 14,000 employees, it is the largest private employer in the state, serving over 580,000 health plan members through Medicare Advantage, Medicaid, and Commercial plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.