Posted: Wednesday, December 27, 2017 3:30 PM
Employment Status:AF : Active : Regular : Full Time
Job Summary 13;
The Enrollment Specialist is responsible for gathering and verifying healthcare practitioner information and tracking all compliance information related to the enrollment and re:credentialing process. This includes processing all incoming applications to ensure accuracy at completion and that all required licensing and certification documentation is present, as well as all additional required documentation. All necessary file maintenance functions, including updating service locations, rendering provider information; licensure and ownership information is also a function of this position.
Job Responsibilities 13;
:Provides reviews and prepares new hire enrollment packets for accuracy, completeness and timely submission to the payers and maintains current provider information in order to ensure timely reimbursement of payment for services. Performs follow:up with the physicians to request necessary documentation for the application/re:credentialing process (Renewal reminders must be sent 30 days prior to the expiration date).
:Maintains a working knowledge of payers processes and updates and ensures that the physician database and NPPES system is kept accurate and current. CAQH re:attestation to occur every 120 days for all providers.
:Maintains files, scans credentials and monitors expiration dates and notifies administrators and Enrollment Manager of deadlines.
:Initiates phone calls, generates letters and other correspondence as required for follow up with payers to ensure timely receipt of provider participation effective dates and numbers (goal is within 60 days of payer receipt date of the application). Assures that all contacts and discussion with payers are documented and maintained, as well as copies of emails and/or written correspondence sent to third party payers, for future reference.
:Reviews and provides research results to the Billing Department to assist with claims issue resolution. 13;
Required Licenses, Certifications, Registrations 13;
Required Education and Experience 13;
:High School Diploma or equivalent with a minimum of 3 years of medical insurance experience. 13;
Preferred Education, Experience and Cert/Lic 13;
:Experience with billing and/or provider relations.
:Knowledge with large healthcare organizations, Medicare and Medicaid policies and procedures. 13;
Additional Technical Requirements 13;
:Detail oriented, task oriented, problem solving and reasoning skills, works individually as well as in a team environment
:Proficiency with MS Word, Power Point, Excel computer programs is required. Knowledge of the ECHO and CAQH system is preferred 13;
All CHOP employees who work in a patient building or who provide patient care are required to receive an annual influenza vaccine unless they are granted a medical or religious exemption.
Childrens Hospital of Philadelphia is committed to providing a safe and healthy environment for its patients, family members, visitors and employees. In an effort to achieve this goal, employment at Childrens Hospital of Philadelphia, other than for positions with regularly scheduled hours in New Jersey, is contingent upon an attestation that the job applicant does not use tobacco products or nicotine in any form and a negative nicotine screen (the latter occurs after a job offer).
Childrens Hospital of Philadelphia is an equal opportunity employer. We do not discriminate on the basis of race, color, gender, gender identity, sexual orientation, age, religion, national or ethnic origin, disability or protected veteran status.
VEVRAA Federal Contractor/Seeking priority referrals for protected veterans. our hiring official with any referrals or questions.
CHOP Careers Contact
2716 South Street, 6th Floor
Philadelphia, PA 19146
• Location: South Jersey
• Post ID: 50372857 southjersey