Provider Enrollment Coordinator - Florida, United States - Remote - Full-time

 About the job

Overview

Unified is a nationwide community of providers, operations specialists and thought leaders who look for the greatest opportunities to impact every woman’s health, at every stage of their journeys. We are unparalleled in our scale and ability to adapt to address unmet and underserved needs. Through 815+ clinics, 23 IVF labs, nationwide telehealth capabilities and targeted case management, our 2,700+ independent, affiliated providers deliver comprehensive women’s health services and continuously work to implement methods and develop techniques or platforms that improve the healthcare experience.

We are currently seeking a Provider Enrollment Coordinator. The Provider Enrollment Coordinator is responsible for preparing and submitting all types of credentialing/enrollment applications and supporting documentation for enrolling providers and groups with payers. The Provider Enrollment Coordinator follows up on the status of applications for all practitioners and payers, tracking progression on all pending and completed applications.

Responsibilities

• Preparing and submitting all provider credentialing applications and conducting necessary follow-up.
• Maintain follow-up guidelines for enrollment/credentialing applications and provide Care Centers with status updates. Communicate with other departments with updates as needed.
• Maintain a strict level of confidentiality for all matters pertaining to provider credentials
• Ensuring credentialing data needed for enrollment, contracting, and other related purposes is on file. Credentialing data includes but is not limited to the Medical Degree, Internship/Residency certification, Drug Enforcement Administration (DEA) verification of number, Board Certifications, CV, malpractice insurance and medical history.
• Work closely with Care Centers and provider to obtain missing documentation for providers pertaining to enrollment activities.
• Maintain provider information via Credentialing Software including demographics for all providers. The status of payer enrollment (PE) applications must be tracked in credentialing database and Salesforce.
• Maintain provider credentialing files electronically via credentialing software, shared computer files, and CAQH (Council for Affordable Quality Healthcare).
• Processes reappointment applications for the payers.
• Ability to determine the contracting status such as PHO (type of PHO) delegated or not delegated and notify manager accordingly.
• Manage new care center start-up, group enrollment and special projects.
• Notify proper departments and provider/care center of participation status with all payers as the provider becomes PAR or as requested from the provider/care center.
• Resolve issues related to provider participation.
• Conduct training as needed regarding payer enrollment
• Comply with Unified policies and procedures
• Other duties as assigned, directed, or requested

Qualifications

• Bachelor’s degree from an accredited university preferred or 3 years minimum experience in a payer enrollment related field
• Knowledge and thorough understanding of managed care operations including enrollment, credentialing, contracting and claims
• Knowledge of payer processes, local, state, and federal requirements
• Excellent written and oral communication skills
• Demonstrated proficiency in Microsoft Office products including word, excel, and outlook
• Strong organizational, problem solving and decision-making skills
• Ability to prioritize and manage multiple issues effectively and simultaneously
• Self-motivated and self-starter who can work well under minimal supervision
• Strong attention to detail, research and follow up skills
• Ability to work both independently and in a team setting
• Excellent planning, organizational, and time management skills required.
• Able to learn and adapt to continuously changing business and technology needs.
• Extend work hours, if required depending on deadlines and events

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