Credentialing/Payor Enrollment Specialist

MedStar Health
remote work
United States, D.C., Washington
Dec 24, 2024
General Summary of Position MedStar Health is seeking an experienced Credentialing/Payor Enrollment Specialist to join our MedStar Health Physical Therapy team! In this role you will utilize your strong organizational, interpersonal and critical thinking skills to process the enrollment and credentialing for the MedStar Physical Therapy outpatient sites and therapists. This is a Full-Time, Monday - Friday dayshift position where the selected candidate will enjoy a remote schedule with the opportunity to work from home with infrequent on-site requirements. Join one of the largest healthcare systems in the Baltimore-Washington metro region, also recognized as one of the "Healthiest Maryland Businesses". Apply today and learn how MedStar Health can be your next great career move! As a Credentialing/Payroll Enrollment Specialist you will facilitate the process of governmental enrollment and managed care insurance credentialing/re-credentialing for outpatient physical therapy network therapists with all contracted insurance plans for all outpatient locations. Also facilitates the credentialing/re-credentialing process for MedStar Health Physical Therapy outpatient facilities. Oversees internal delegated credentialing audits in partnership with managed care. Builds and maintains positive relationships with managed care insurance/payors and serves as a central point of contact for outpatient physical therapy regarding credentialing & enrollment related issues. Primary Duties: * Coordinates, monitors and maintains the credentialing/recredentialing of all practitioners employed and/or contracted. Completes and sends managed care and governmental applications to practitioner for signature and coordinates the signing of the applications with the delegated/authorized official. Also completes credentialing/recredentialing applications on behalf of MedStar Health Physical Therapy outpatient facilities. * Coordinates with the credentialing verification office to ensure full compliance with credentialing guidelines and approvals. Serves as administrative lead for the credentialing committee and coordinates all activities related to credentialing approvals and follow up. * Tracks, monitors and follows up with managed care organizations and governmental programs regarding enrollment status and practitioner numbers. Works closely with these payors in order to expedite the enrollment process to ensure that practitioners are being enrolled and added to payor networks. * Responsible for maintaining the accuracy and integrity of the credentialing/enrollment database. * Generates and oversees the distribution of reports for delegated rosters for delegated agreements. * Coordinates and oversees the internal delegated credentialing audits in conjunction with managed care which include generating reports, preparing files for audit review and tracking & monitoring the audit outcome. * Independently handles requests, for additional information, from managed care organizations & governmental programs. Also identifies and responds pro-actively to issues and concerns regarding practitioner set up. * Notifies managed care organizations and governmental programs of practitioner changes (such as, address changes, name changes, terminations, etc.). Provides oral and written follow-up to the managed care organizations and governmental programs to confirm the changes have been made. * Generates and distributes practitioner number reports upon request. Constantly seeks out ways to improve communication and the flow of information to our internal and external customers. * Works closely with internal finance and managed care to resolve enrollment delays so that outstanding claims maybe resolved and released. Participates in meetings/calls with internal customers to ensure continued communication and timely resolution of outstanding billing, payment & practitioner enrollment issues. * Works pro-actively with managed care and governmental programs to stay current on enrollment policies and regulations governing Minimum Qualifications Education Bachelor's degree (or equivalent work experience) in business or related health care discipline preferred Extensive knowledge of managed care enrollment and contracting procedures required Experience 5-7 years health care experience in managed care and governmental credentialing, payor relations and provider relations including experience working for a managed care insurance plan required Experience with provider and facility credentialing process, and experience completing managed care and governmental credentialing applications required Knowledge, Skills, and Abilities Excellent verbal and written communication skills. Strong organizational, interpersonal, and critical thinking skills. Ability to work independently with minimum supervision. Ability to analyze and evaluate data and other provider related problems and to develop alternative solutions for a positive outcome. Must be able to multi-task and prioritize workload and pay meticulous attention to detail. Proficient in Microsoft Office software programs (Word, Excel, and PowerPoint). Credentialing software experience required. This position has a hiring range of $23.19 - $40.61