PeaceHealth is seeking a Provider Data Specialist Lead-Payer Enrollment for a Full Time, 1.00 FTE, Day position. Hourly compensation starts at $23.42, more depending on experience.
Must be fully vaccinated for COVID-19 including 2 doses of a 2-dose series or 1 dose of a 1-dose series plus 14 days beyond the final dose prior to start date.
This position can be performed fully remote. If telecommuting, PeaceHealth will provide the caregiver with necessary computer equipment. It is the responsibility of the caregiver to provide Internet access. Caregiver must reside in OR, WA, or AK.
Responsible for coordinating, processing, monitoring and maintaining the Provider Enrollment process for Employed and allied health practitioners, ensuring timeliness and compliance with PeaceHealth standards and criteria as well as all legal, regulatory and accreditation requirements. Responsible for the accuracy and integrity of the Payer Enrollment-related data within the credentialing/enrollment database system. Coordinates Payer Enrollment service processes for governmental and non-delegated third-party payers for Providers associated with PeaceHealth.
- Initiates, coordinates, processes and monitors initial and reappointment Payer applications in accordance policies, timelines regulatory and accreditation requirements. Maintains tracking mechanisms.
- Assigns work; plans and coordinates priorities, provides technical assistance, monitors quality of work, monitor team projects, mentors staff, provide constructive feedback, oversee staff training, ensures quality improvement, provides leadership feedback on staff performance, and assists with goal setting for the team.
- Serves as department database super-user and trainer. Assists in decision making and acts as advisor for database use, user field customization.
- Ensures timely enrollment of new providers with 3rd party and government payers; and maintenance of existing active physicians and advanced practice providers Submits termination requests to health plans. Assists with the delegated credentialing program.
- Maintains enrollment files and related records. Processes application requests from contracted entities; ensures correct application forms and complete packets are sent to provider; maintains tracking mechanisms.
- Communicates with practitioners regarding enrollment files and processes. Maintains database and other records to ensure release of information is performed according to established policies and legal requirements.
- Prepares and submits applications for new providers and submits them to PeaceHealth contracted payers and government health plans. Processes credentialed provider demographic changes and resignations. Communicates and follows up with providers regarding new provider enrollment, licensing, and DEA requirements for new providers and questions.
- Serve as a stakeholder in system upgrades and implementations. Ensures technical understanding enhancements and fixes being delivered by the vendor as part of their system maintenance programs.
- Performs other duties as assigned.
- High School Diploma or equivalent.
- Associates Degree preferred or equivalent combination of education and experience that provides the requisite knowledge, skills and abilities to perform the job.
- Minimum of 3 years credential verification or payer enrollment or healthcare administration required.
- Certification by the National Association of Medical Staff Services (NAMSS) as a Certified Professional Credentialing Specialist (CPCS) and/or Certified Professional Medical Staff Management (CPMSM); if not currently CPCS or CPMSM certified, must obtain certification within 3 years of date of hire.
- Excellent critical thinking and problem-solving skills
- Detail oriented with demonstrated accuracy, organizational and time management skills.
- Working knowledge of credentialing database software.
- Knowledge of legal, regulatory and accreditation credentialing requirements preferred
- Proficiency in MS Office applications, i.e. word, excel
- Excellent verbal and written communication skills
- Excellent customer service skills
- Ability to manage multiple priorities, projects and display flexibility in a fast paced and challenging work environment.
- Knowledge of medical terminology preferred.
- Work requires fairly light physical exertion from up to 65% of the time
- Ability to lift objects weighing 30 lbs. or less.
- Work is performed under normal working conditions with adequate lighting and ventilation.
- Job duties frequently require intense concentration and attention to detail (up to 65% of work time).
See how PeaceHealth is committed to Inclusivity, Respect for Diversity and Cultural Humility.
For full consideration of your skills and abilities, please attach a current resume with your application. EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.