Job Information
Planned Parenthood of Central and Western NY Payer Enrollment & Credentialing Specialist in WFH Flexible • Syracuse, New York
Payer Enrollment & Credentialing Specialist
WFH Flexible • Syracuse, NY (http://maps.google.com/maps?q=1120+East+Genesee+St+Syracuse+NY+USA+13210) • Revenue Cycle
Job Type
Full-time
Description
Payer Enrollment & Credentialing SpecialistAffiliate Wide - Buffalo, Rochester, & Syracuse, NY
Planned Parenthood of Central and Western New York (PPCWNY) protects and provides health care and education that empowers individuals and families. With respect. Without judgment.No matter what.
Diversity and inclusion are core values and PPCWNY strives to recruit exceptional and diverse staff. PPCWNY strives to develop staff into leaders for a diverse and global workplace.
In support of PPCWNY’s mission, thePayer Enrollment & Credentialing Specialisthas responsibility for the timely completion of complex government and commercial payer enrollment applications for all clinicians within CAQH and other credentialing entities, maintaining and updating information from all providers, and credential verification is submitted and authenticated. The Payer Enrollment & Credentialing Specialist will maintain contracts with all payer sources, updating a list of paneled staff, and communicating any difficulties to management promptly. Position has remote working opportunity.
Essential Functions
Maintains all pertinent credentialing documentation (e.g., CAQH, ETINs)
Verifies providers credentials by obtaining primary source verification through contracted CVO
Recredentials provider credentials for health plans through CVO as required
Tracks with advanced notification of all expiring licenses etc. and to function as the liaison between the practice and the insurance carriers with all matters relating to the credentialing / re-credentialing process
Create detailed insurance matrix for each practitioner which lists the individual physician, each insurance carrier and the physician’s status with the plan (updated each time there is a change in status)
NPI (National Provider Identifier) Management: NPI implementation and maintenance in the NPPES system
Performs follow-up with insurance payers via phone, email, or website to resolve payer credentialing issues
Monitors the review and analysis of practitioner applications and enclosed documents, ensuring applicant eligibility
Work closely with site management and resources to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc.
Process initial and re-credentialing applications for primary source verification as set in the CVO policy and accreditation standards for PPFA
Initiate and hold meetings with affiliates to accurately report all payer enrollment and credentialing status while gathering pertinent affiliate updates
Under the direction of the Regional Director, create policies and procedures for payer enrollment and credentialing
Keep Regional Director apprised of payer enrollment and credentialing issues to mitigate risk
Understand specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation and CMS/Medicare, Medicaid, and commercial payer guidelines
Ability to travel to all Shared Service locates as assigned
Maintains strict confidentiality to protected health information understands HIPAA Privacy Security policies and procedures
Other Accountability Activities
Performs other duties as assigned
Shows respect to all internal and external customers for differences in backgrounds, lifestyles, viewpoints and needs in areas such as race, gender, ethnicity, creed, sexual orientation and others
Requirements
Qualifications
Applicants must possess the following qualifications (or equivalent combination of education and experience):
Education—
- Associate or bachelor’s degree in health administration or business preferred or equivalent work experience
Experience—
- Minimum one-year experience with credentialing and/or payer enrollment required
Certifications—
- Notary Public certification required within one year of hire.
Knowledge, Skills, & Abilities:
Ability to organize and prioritize work and manage multiple priorities
Must be flexible with the ability to work well in a team environment
Strong analytical and problem-solving skills
Strong Microsoft Office and Smartsheet experience required
Ability to work independently with minimal supervision
Must maintain working relationships with clinicians, physicians, management, staff, and contacts outside the organization
Exceptional communication skills (verbal and written), interpersonal skills and English grammar and usage
Excellent attention to detail
Ability to read, interpret and apply policies, procedures, laws, and regulations
Planned Parenthood seeks candidates who have experience working with diverse racial and socio-economic populations, including African Americans, Hispanics, or other racial and ethnic groups
A commitment to Planned Parenthood of Central Western New York’s (PPCWNY) mission, vision, and values along with a commitment to providing services to a diverse range of clients and to the goals of CWNY is essential
Physical Requirements
Possess sufficient mobility to perform the Essential Functions listed in this Job Description with or without an accommodation
Ability to travel to all agency locations as assigned
Work ScheduleThis is a full-time, 40 hour a week, position; regular schedule will be Monday - Friday with occasional evenings.
Benefits & CompensationAt PPCWNY, we are committed to equitable compensation practices and transparency. In alignment with these efforts, the pay for this position ranges from $19.40 to $22.46/hour. Actual compensation will be determined by experience and other factors permitted by law.
In addition to competitive compensation, PPCWNY offers an extensive benefits package with generous Paid Time Off, 10 paid holidays, affordable medical, dental, and vision options, Health Savings Account or Flexible Spending Account, 401(k) with match, and much more!
Planned Parenthood of Central and Western New York is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, protected veteran status, or status as a qualified individual with disability.We are committed to workforce diversity and aspire to reflect the communities we serve. To that end, we strongly encourage people of color, LGBTQ identifying individuals, people with disabilities and other underrepresented groups to apply.
Salary Description
$19.40 to $22.46/hour