Provider Enrollment Specialist

🔥 7 hours ago

⚔️ Virginia, West Virginia – Remote

⚔️ Virginia – Remote ⛰️ West Virginia – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 10%

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WVU Medicine

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

Healthcare • Healthcare Insurance

WVU Medicine is a comprehensive health system affiliated with West Virginia University, providing medical services through a network of hospitals across West Virginia. The system includes notable facilities such as J. W. Ruby Memorial Hospital, WVU Medicine Children's, and various other regional medical centers. WVU Medicine offers a wide range of healthcare services, including specialized and advanced medical treatments such as robotic heart surgery. It's also involved in medical education, research, and community health initiatives, emphasizing a mission of delivering high-quality care to the communities it serves.

📋 Description

• Manage timely, efficient, and accurate economic credentialing and provider enrollment for medical billing providers and facilities • Guide providers through credentialing, enrollment, recredentialing, and revalidation processes for managed care, Medicare, Medicaid, NPPES, and I&A • Develop, maintain, and monitor credentialing and enrollment databases with applicable effective dates • Ensure active status among contracted managed care payers, Medicare, Medicaid, and other governmental plans • Verify that licenses and certifications are accurate and active across all markets • Track registration packets and alert hiring managers or recruiters about issues • Develop and manage reports tracking registration and communicating enrollment status to leadership and billing units • Coordinate with leaders to add facilities, practice locations, providers, and services under existing contracts • Serve as an educational resource and consultant regarding enrollment of facilities, practice locations, and provider types • Analyze and troubleshoot credentialing and provider enrollment issues affecting payment • Resolve issues, recommend solutions, or escalate complex matters • Collaborate with the Director of Professional Services, Manager of Professional Services, and Supervisor of Managed Care on daily operations and special projects • Maintain confidentiality

🎯 Requirements

• High School Diploma or equivalent • Two (2) years of health care industry experience • Basic understanding of messenger model network and managed care contracting as related to the credentialing process • Basic knowledge of credentialing policies, regulatory requirements and accreditation standards • Strong analytical, problem-solving, time management, planning and organizational skills • Excellent attention to detail and accuracy • Ability to function independently with minimal supervision in a demanding and fast-paced environment • Intermediate skill level in Microsoft Word, Excel, Access, and Outlook • Ability to establish and maintain effective working relationships with providers, staff, and other agencies • Positive service attitude when dealing with internal and external customers

🏖️ Benefits

• Full-time position • 40 scheduled hours per week