Provider Enrollment Application Process Representative in Brentwood, TN at Parallon

Date Posted: 4/23/2018

Job Snapshot

Job Description

Parallon believes that organizations that continuously learn and improve will thrive. That's why, after more than a decade, Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future. 

As one of the healthcare industry's leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized services in the areas of revenue cycle, purchasing, supply chain, technology, workforce management and consulting. 

Parallon's purpose is simple. We serve and enable those who care for and improve human life in their communities. 

JOB TITLE: Provider Enrollment Application Process Representative

GENERAL SUMMARY OF DUTIES: Responsible for and processing Payor Applications which includes but is not limited to Medicare, Medicaid, Blue Cross, local HMO's etc.

SUPERVISOR: Provider Enrollment Manager

SUPERVISES: NIA

DUTIES INCLUDE BUT ARE NOT LIMITED TO:
1. Processes all new and established provider/group Payor applications in accordance with policies and procedures which includes but is not limited to: review, completion, highlighting and mailing of applications to Providers for Signature and to Payors for processing
2. Updates Provider/Payor records in Provider Enrollment System
3. Performs duties in accordance with defined policies and procedures and meets departmental Service Level Agreements associated with their area of responsibility
4. Provides excellent Customer services to all external and internal customers
5. Meet and maintain working knowledge of workflow, systems and tools used in the department
6. Maintain working knowledge of National Committee for Quality Assurance (NQA) guidelines and state requirements.
7. Assist during payor-delegated credentialing audits
8. Work closely with Provider Enrollment Manager to resolve credentialing file issues
9. Prepare credentialing files for presentation to the Credentialing Committee or the Chief Medical Officer (CMO)
10. Monitor inventory, including provisional, credentialing, and recredentialing for all providers as well as expirables to meet payor requirements
11. Work with payors and providers to ensure compliance with enrollment process
12. Ensure payor requirements for submission of rosters are met
13. Confirm completeness and accuracy of credentialing files prior to committee presentation
14. Practices and adheres to the "Code of Conduct" philosophy and "Mission and Value Statement"
15. Other duties as assigned

KNOWLEDGE, SKILLS & ABILITIES

Communication - communicates clearly and concisely, verbally and in writing, utilizing proper punctuation and correct spelling

Leadership - guides individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services

PC skills - demonstrates proficiency in Microsoft Office applications and others as required

Tactical execution - oversees the development, deployment, and direction of complex programs and processes

Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures, and systems

• Customer Service Orientated
• Data entry skills
• Problem solving and analytical skills
• Mathematical skills
• Strong PC skills
• Skills in technology such as word processors, spreadsheets, databases, schedulers, etc.
• Ability to maintain confidentiality

EDUCATION
• High School Diploma (Required)
• Associates Degree (Preferred)

EXPERIENCE
Minimum of 6 months Provider Enrollment experience.
Knowledge of provider credentialing and primary source verification, National Committee for Quality Assurance (NCQA) policies and procedures, state specific certificate and licensure requirements and site visit requirements, National Plan and Provider Enumeration System (NPPES) and Council for Affordable Quality Healthcare (CAQH) preferred. 
Certified Provider Credentialing Specialist (CPCS) preferred. 

CERTIFICATION/LICENSE: N/A

PHYSICAL DEMANDS/WORKING CONDITIONS: Requires prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 25 pounds occasionally. Work is performed in an office environment. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations.