Job Description
Payor Enrollment Specialist
Requisition ID
2024-48354
Category
Professional
Overview
The Payor Enrollment Specialist serves as a contact for multispecialty medical groups regarding provider enrollment with out-of-state Medicaid plans. The specialist coordinates provider enrollment functions for physicians and allied health professionals' participation in out-of-state Medicaid plans for all applicable billing sites.
Why Nationwide Children's Hospital?
The moment you walk through our doors, you feel it. When you meet our patient families, you believe it. And when you talk with anyone who works here, you want to be part of it. Welcome to Nationwide Children's Hospital, Where Passion Meets Purpose.
Here, Diversity, Equity and Inclusion are integrated into our core values and practices. We are passionate about building, sustaining and evolving an inclusive and equitable environment. We are seeking individuals who live these values and want to share their experiences and efforts in support of our collective mission.
We're 14,000 strong. And it takes every one of us to improve the lives of the kids we care for, and the kids around the world we'll never meet. Kids who live healthier, fuller lives because of the knowledge we share. We know it takes a Collaborative Culture to deliver on our promise to provide the very best, innovative care and to foster new discoveries, made possible by the most groundbreaking research. Anywhere.
Ask anyone with a Nationwide Children's badge what they do for a living. They'll tell you it's More Than a Job. It's a calling. It's a chance to use and grow your talent to make an impact that truly matters. Because here, we exist simply to help children everywhere.
Nationwide Children's Hospital. A Place to Be Proud.
Responsibilities
* Coordinates and performs payor enrollment functions for all out-of-state Medicaid plans to ensure providers are actively enrolled. Completes and monitors provider revalidations as needed. Notifies payors and updates pertinent databases when providers are terminated.
* Updates providers licensure, certifications, DEA, and liability information in Council for Affordable and Quality Healthcare (CAQH) and NCH credentialing databases. Assists with revalidating CAQH for providers.
* Prepares out-of-state Medicaid application packets for participating providers. Maintains communication with providers to ensure required documentation is obtained. Distributes mail, faxes, and monitors Payor Enrollment inbox on a weekly basis.
* Acts as a liaison between providers, insurance companies, hospitals, and other facilities to address questions regarding provider enrollment for out-of-state Medicaid plans.
* Tracks status level of privileges at NCH and other hospitals, malpractice coverage history for each physician, and status of enrollment with various carriers. Collaborates quarterly to update external hospital affiliations with NCH providers.
* Collaborates with NCH Patient Accounts to review denied claims for providers not credentialed with out-of-state Medicaid plans to ensure providers are actively enrolled for claims to process.
* Prepares and submits paperwork required to grant OSU privileges to physicians.
Qualifications
Education:
* High school diploma, required.
* Associates or Bachelor's degree in business, health care administration or equivalent professional experience in payor enrollment/credentialing, preferred.
Skills:
* Basic typing skills and working knowledge of Microsoft Office.
* Excellent communication skills both verbal and written.
* Ability to establish and maintain effective working relationships with providers, management, staff, and external contacts.
* Ability to work independently with minimal supervision.
* Ability to research/analyze data, organize and prioritize work, and manage multiple priorities.
Experience:
* One to three years of medical terminology experience or medical background, preferred.
* Two to three years Payor Enrollment or Credentialing experience, preferred.
* Previous medical billing experience, desired.
The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individual so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under his/her supervision.
OCCASIONALLY: 1-33% OF THE TIME (0.5 TO 2.5 HOURS) Bend/twist Problem solving Decision making Interpreting data CONTINUOUSLY: 67-100% OF THE TIME (5.1 TO 12 HOURS OR GREATER) Sitting Flexing/extending of neck Reaching above shoulder Hand usage: grasping, gripping, turning Repetitive hand/arm usage Use of Computer skills Seeing- far/near
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EOE M/F/Disability/Vet
