Job Summary The Payor Enrollment Specialist is responsible for providing enrollment and payor credentialing information to insurance and health plans to support the processing of payor applications and reapplications. Provides enrollment support to the centralized appointment and reappointment process including reports and obtaining required data from the health plans and appropriate internal departments, in accordance with all appropriate regulatory agencies standards
Provides payor enrollment and credentialing support to the credentialing manager. Maintains a sound working knowledge of payor enrollment, payor credentialing and provides consultation regarding payor enrollment and credentialing, to ensure all processes are in compliance with state statutes and regulatory agencies as demonstrated by observation.
Responsible for timely processing of health plan initial applications and reappointment applications for completeness and in accordance with appropriate standards. Communicates with health plans during enrollment process to ensure timely and expeditious completion of process. Researches incidents, submission of applications for timely processing and uploading to payors, maintains accurate effective dates and request appropriate follow-up information from payors or other sources as indicated. May be responsible for gathering information and perform research in contract disputes between health plans and providers.
Maintains the payor enrollment and credentialing database for physician and faculty. Ensures data is accurately entered as evidenced by audit. Prepares reports in compliance with requests for information as demonstrated by documentation.
Maintains adherence to professional confidentiality standards established within the Department and in accordance with legal, ethical and hospital, payor enrollment and credentialing, and medical staff policies. Assures data security and confidentiality by use of appropriate labeling of information and storage, and appropriately securing cabinets and drawers.
Performs other duties as assigned.
Education High School Diploma or GED Required
Experience Two (2) years' credentialing, payor enrollment, medical staff or administrative assistant including data entry, in a hospital or healthcare environment. Required
Internal Number: 2019-16907
Let’s transform healthcare together.
Every day, we bring patients convenient, coordinated access to healthcare while providing meaningful service to our community.
Join us and you will:
Develop professionally and achieve your career goals
Enrich your life with a focus on wellness
Enjoy a compassionate, caring culture with outreach to our local communities
Support the well-being of you and your family with a diverse portfolio of benefits
Welcome to HonorHealth.
We are a non-profit, local healthcare organization known for community service and outstanding medical quality. Our organization encompasses five acute care hospitals with approximately 10,500 employees and 3,100 volunteers, urgent care centers, clinical research, medical education, an inpatient rehabilitation hospital, an Accountable Care Organization, two foundations, and extensive community services.