System Payor Enrollment Specialist (Full-time; Days) - LCMC Health Corporate at LCMC Health System

Job description

Your job is more than a job This job description is intended to describe the general nature and level of work performed by employees assigned to this department. This is not an exhaustive list of all duties and responsibilities, and LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary. GENERAL DUTIES: Payor Enrollments: Facilitate the enrollment and credentialing/re-credentialing process with various payers, to include but not limited to Medicare, Medicaid, and Commercial Insurance Plans. Technical: ​ Manages the credentialing and re-credentialing process as well as assist providers with accurate completion of enrollment process to ensure deadlines are met. Ensures timely credentialing is done for new providers with each payer and notify physicians, scheduling and billing offices of incomplete credentialing and expected approval date to ensure clean billing. Engages in communicating with payor representatives to ensure completion and revalidation requests have been completed and participation dates are accurate. Maintain electronic files related to applications submitted, approval notifications, and all other supporting provider documentation that may be needed for payor enrollments. Maintain up-to-date knowledge of payor regulations, guidelines, and requirements to ensure NCQA (National Committee for Quality Assurance) compliance. Collaborate with internal stakeholders, including billing and coding teams, to resolve payor-related issues and streamline processes. Perform thorough verification and validation of provider information to prevent enrollment delays and billing errors. Ensure the ongoing accuracy and completeness of provider profiles within the CAQH (Council for Affordable Quality Healthcare) and internal systems. Stay informed about changes in healthcare policies, reimbursement rates, and coding standards that may impact payor enrollment. Develop and maintain strong relationships with payor representatives to expedite and troubleshoot enrollment processes. Conduct regular updates to provider directories and perform quarterly maintenance activities. Participate in training sessions and workshops to enhance knowledge and skills related to payor enrollment and healthcare regulations. Cooperates with others to balance the workload and meet project deadlines of the department. Utilize knowledge of enrollment processes in multiple states and stay current with state-specific regulations. Analytics: Keeps management updated on status of payor enrollment and/or any matters requiring attention via scheduled documented reporting. Generates and monitors monthly/periodic provider reports to determine outstanding claims, payor enrollment status, status of providers and other credentialing data. Collaboration: Collaborates with medical staff office as well as cross-functional team members to record updates to ensure credentialing process is smooth and claims are processes correctly. Ensures smooth functioning of the physician practice plan to ensure updates are received when/if credentialing is delayed. EXPERIENCE/EDUCATION QUALIFICATIONS Required: High School Diploma/GED or equivalent OR 2 years of experience in administrative support, insurance enrollment, payer credentialing, billing, or like field. KNOWLEDGE, SKILLS, AND ABILITIES Input data accurately into appropriate system and maintain records/database to ensure up-to-date information. Excellent organizational skills, oral and written skills. Ability to follow-up on pending items and critical thinking. Ability to act independently and ability to maintain confidentiality. Competency in Microsoft Office, specifically Excel, Outlook, PowerPoint and Word. Ability to take and transcribe minutes. REPORTING RELATIONSHIPS Does this position formally supervise employees? No FUNCTIONAL DEMANDS Light: Light physical requirements- Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequen