UofL Physicians

Provider Enrollment Specialist

US-KY-Louisville
Job ID
2017-4195
# of Openings
1
Category
Administrative/Finance

Overview

JOB SUMMARY:

To perform and ensure the quality and timeliness of provider enrollment functions and to meet department and company objectives. Help to ensure adherence to Payor contracts, internal Policies and Procedures, and NCQA Accreditation Standards.

Responsibilities

PRIMARY REPONSIBILITIES

  • Perform provider enrollment functions, including but not limited to: CAQH on line application system (OAS), Cactus credentialing system, NPI application, enrollment applications for government Payors such as Medicare and Medicaid, and enrollment activities for managed care Payors,
  • Prepare hospital, Kentucky license and DEA applications, and coordinate with the University groups/clinics to obtain necessary and timely signatures for the applications.
  • Track provider enrollment applications and communication of status to the University groups/clinics to ensure timely enrollment and linkage of providers with Payors.
  • Upon receipt of the ID numbers, immediately notify the University groups/clinics. Resolve any irregularities immediately.
  • Update CACTUS credentialing database as necessary, and CAQH as necessary, to reflect accurate, current information.
  • Complete, count, and prepare regular provider enrollment status reports for distribution internal and external constituents to the University groups/clinics.
  • Complete CAQH re-attestation tasks for University Louisville Physicians practitioners and physicians.
  • Respond to practitioner, physicians, office staff, practice leadership and all requests. Document and assist in resolving practitioner, [practice issues involving provider enrollment.
  • At the direction of the Manager, development department documents, forms, policies and procedures. Make recommendations and suggestion to improve process flow and related documents and procedures.
  • Other duties as assigned by the Manager, Credentialing & Enrollment Services, to assure compliance with established policies and procedures in the Department.

JOB RESPONSIBILITIES:

  • Proficient in provider enrollment and billing processes and procedures.
  • Knowledge of Payor contracts and procedures for both government and commercial
  • Proficient in NCQA standards and procedures.
  • Exceptional organizational skills and attention to detail.
  • Extensive knowledge of Windows, Word, Excel, and Internet applications.
  • CPCS or CPMSM Certification strongly preferred as soon as eligible.
  • Proficient with CACTUS software or other Credentialing systems required.
  • Must have initiative and be able to work independently, and in a high volume team system.
  • Must be able to communicate effectively and professionally with private, state and federal agencies, as well as practitioners and clients, in order to investigate, collect information, and resolve issues.
  • Must be able to effectively and professionally interact and communicate with all associates as needed concerning credentialing issues.

Qualifications

PHYSICAL DEMANDS / WORK ENVIRONMENT

  • Works in well lighted/ventilated office area.
  • Is subject to interruptions.
  • Extended periods of time in a seated position.
  • Lifting (up to 20 pounds), bending, stooping.
  • Overtime may occasionally be required.
  • Must be able to communicate via spoken and written word, proficiently in English.

EDUCATION/ REQUIREMENTS

  • Bachelor’s degree required, or equivalent experience.
  • Minimum of 3 years in Credentialing, Provider Enrollment Managed Care, Billing, or related field

JOB REQUIREMENTS

  • Candidates upon hire will complete an electronic I-9 verification.
  • Only those candidates whose experience best meets our requirements will be contacted.
  • University of Louisville Physicians is an Equal Opportunity Employer.
  • Current UofL Physicians employees must follow the UofL Physicians Internal Transfer Policy.

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