[Remote] Payer Enrollment-Network Coordinator

Note: The job is a remote job and is open to candidates in USA. UnityPoint Health is seeking a Payer Enrollment & Network Coordinator to join our team! This position prepares and submits payer credentialing and re-credentialing applications on behalf of providers and clients, monitors application status and performs necessary follow-up, as well as maintains accurate provider records in the systemwide credentialing database.

Responsibilities

• Promptly and accurately record all provider information in the system of record
• Responsible for the completion and submission of all payer initial and re-credentialing applications in the required format
• Monitor status of payer applications to ensure completion
• Coordinate with IT the creation and maintenance of provider payer panel records (EDI table) in Epic
• Assist with researching claim issues brought forward from clinic administrators and customer service staff
• Monitor claim denial reports to further investigate payer panel roster errors
• Responsbile for the initiation and follow through on all aspects of provider credentialing including: initial and recredentialing process for all practitioners including performance of primary source verification in accordance with Medimore, Inc. policies and procedures, hospital medical staff bylaws and requirements, NCQA, URAQ, JCAHO, DNV, CMS and other regulatory agency guidelines
• Responsble for responding to requests for provider credentialing and contracting information timely
• Develop, maintain and distribute reporting as required
• Work with UnityPoint Health Medical Staff offices and physician practice administrative staff to support credentialing needs
• Maintain an efficient and effective confidential filing system for Medimore, Inc. provider files
• Identify and report any non-compliance or credentialing issues to the Network Manager
• Establish regular communication and respond to health professionals, provider representatives, or other essential departments the status of applications, the status in the credentialing process and the status of participation with health plans
• Enter and maintain accurate provider data in the organization credentialing database. Audit, correct and communicate to all appropiate parties, corrections of provider data in the credentialing database
• Responsible for the collection of data to efficiently onboard new providers for payor enrollment
• Coordinate with any and all UnityPoint Health customers to collect all data necessary for all payer applications and submissions
• Open Morrisey process for new providers within 5 days of receipt of application
• Complete payer applications for new providers within 30 days of compleate applicaiton
• Regularly communicate with hospital medical staff offices to coordinate application packets for new providers

Skills

• High school diploma or equivalent
• Minimum of 2 years of experience in the field of payer credentialing and enrollment, provider billing services, or health clinic customer service positions
• Knowledge of the managed healthcare industry
• Proficient in Microsoft Office Suite
• Knowledge of regulatory agency standards (i.e. NCQA, URAQ, JCAHO, etc)
• Excellent communication skills both written and verbal
• Associates degree
• Current experience with submission of payer applications

Benefits

• Paid time off
• Parental leave
• 401K matching
• Employee recognition program
• Dental and health insurance
• Paid holidays
• Short and long-term disability
• Pet insurance
• Early access to earned wages with Daily Pay
• Tuition reimbursement
• Adoption assistance

Company Overview

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