Provider Enrollment Specialist
Steward Health Care System LLC ("Steward") is a fully integrated, physician-led national health care services organization committed to providing the highest quality of care in the most cost-efficient manner in the communities where our patients live. Steward - the largest privately held health care company in the U.S. - owns and operates 35 community hospitals across nine states, serves over 1,000 distinct communities and employs approximately 40,000 health care professionals. In addition to our hospitals, the Steward provider network includes 4,800 providers, 25 urgent care centers, 87 preferred skilled nursing facilities, substantial behavioral health offerings, over 7,300 hospital beds under management, and approximately 1.5 million full risk covered lives through the company's managed care and health insurance services.
Steward Medical Group (SMG), Inc. is Steward's multi-specialty group practice with over 4,500 employees including over 1,800 physicians and advanced practitioners. SMG operates approximately 450 practice locations throughout Massachusetts, Southern New Hampshire, Rhode Island, New Jersey, Pennsylvania, Ohio, Florida, Utah, Arizona, Texas, Louisiana and Arkansas, and provides more than 4 million patient encounters per year.
This Provider Enrollment Specialist is responsible for the timely enrollment of new physicians and on-going maintenance of existing providers. Enrollment includes but is not limited to managed care organizations and government payors such as Medicare, MA Medicaid and out of state Medicaid.
• Responsible for data entry of provider enrollment information into Provider Enrollment Database systems and distribution of information to designated department representatives and credentialing administrators.
• Accountable for all aspects of provider enrollment to ensure provider data is loaded appropriately in all relevant systems the first time. This includes understanding and communicating unique arrangements and ensuring the third party payors accurately credential the provider.
• Accountable for directly entering and updating provider data into the CAQH system.
• Follow-up with managed care organizations to ensure expedient credentialing.
• Accurately perform review of new enrollment files for deficiencies.
• Pursue incomplete information with practice contact or provider.
• Ensure third party payor provider enrollment is done in a timely and accurately in order to receive reimbursement.
• Responsible for the implementation and maintenance of provider and third party payor files within practice management software.
• Ensure that practice, provider and payor related tables are established and properly working.
• Responsible for the on-going maintenance of existing providers including but not limited the submission of maintenance forms to update personal and practice demographic data for providers and billing updates.
• Accountable for submitting termination requests to all health plans in a timely manner.
• Other duties as assigned.
• Associates degree required or equivalent combination of education and experience.
• National Association of Medical Staff Services (NAMSS) CPCS certification a plus.
• 3-5 years of working experience in a healthcare setting is required.
• Knowledge of provider credentialing and/or enrollment required.
• Knowledge of billing processes preferred.