"Alerted.org

Employment Type:

Full time

Shift:

Description:

Responsible for completion of applications for provider enrollment for Medicare, Railroad Medicare, BCBS, Medicaid, Managed Care payers, and applicable Commercial payers in a timely manner and when received, notification to appropriate staff. Maintains a working knowledge of applicable federal, state, and local laws and regulations. Coordinates communication between payers and leadership and facilitate resolution of denials. Collaboratively work with several different departments and payer contacts to ensure a timely submission of enrollment applications.

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the MercyOne Mission, Vision, and Values in behaviors, practices, and decisions.

Maintains a working knowledge of applicable Federal, State, and local laws and regulations, NCQA standards, MercyOne Organizational Integrity Program, Standards of Conduct, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

Applies for provider NPI for new Residents to the organization and maintains activity directory of providers NPI log in and password.

Complete Managed Care checklist.

Supplies accurate and timely provider roster to Managed Care payers.

Complete ACO quarterly roster reviews for updates and terminations.

Facilitates the completion of Wellmark credentialing and recredentialing applications.

Facilitates the completions of facility applications.

Follows up on application process as needed for receipt of provider numbers in a timely manner.

Notifies appropriate staff when provider is approved for claims with the Health Plans.

Keeps records of all providers, provider numbers and tax ID numbers.

Verifies with insurance company provider eligibility.

Documents all transactions of the provider application process.

Maintains good working relationship with payer representatives.

Collaborates with payer representatives to assist with claim denials.

Demonstrates flexibility and adapts to changes in workload and assignments. Displays teamwork when co-workers are absent. Assists in reducing others’ backlog. Maintains a positive working relationship with co-workers, medical staff, and personnel of other departments, and assists persons needing help as necessary. Assists in orientation of new employees.

Responsible for system maintenance of Provider Codes and Group Codes.

Responsible to maintain current W-9 forms.

Establishes and maintains Provider database and other systems to assure accuracy of provider information.

Prepares and participates in delegated credentialing oversight audits with commercial health plans.

Operates and maintains all needed equipment, i.e., PC, fax, copier, printers, etc. Knows location and use of manuals pertaining to claims processing. Accesses necessary information using appropriate resources, i.e. manuals, internet, and intranet.

Communicates with internal/external customers/colleagues in a courteous, positive, empathic and professional manner. Speaks to everyone. Always communicates with care. Speaks calmly, clearly, and courteously. Stops and listens when a customer/colleague speaks. Communicates consistently with colleagues in a professional and respectful manner and accepts assignments willingly.

Recognizes and reports problems that may arise to their Supervisor, Manager, or Director.

Attends department meeting regularly and participates in self-evaluations, goal setting, and processes for the benefit of the department/medical center. Attends specific in-services and workshops.

Supports and abides by all medical center departmental, and safety policies and procedures.

Acts in a professional manner reflecting the mission, philosophy and values of MercyOne.

Communicates with and performs duties following MercyOne Service Excellence Standards of Behavior.

Performs other responsibilities as requested by the Supervisor, Manager, or Director

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

EOE including disability/veteran