• Payor and Provider Enrollment Coordinator

    Essentia Health (Fargo, ND)


    Job Description:

    Responsible for ensuring all healthcare practitioners/facilities are properly credentialed/enrolled with all contracted insurance networks and subnetworks. Understands CMS Medicare, Medicaid, and managed care billing, credentialing and enrollment requirements and reimbursements methodologies and applies knowledge to identify, quantify, and address missing/incorrect charges. Assist in the development of resources for researching issues.

    Education Qualifications:

    Key Responsibilities:Responsible for organizations including applications and credentialing for various practitioner’s groups and specialties for which contracting services are providedCompletes audit of signed enrollment applications and required documentation for completeness and accuracyMaintains and updates all credentialing systems with current information for all physicians/providersResponsible for coordinating and maintaining all credentialing documents necessary to complete credentialing and re-credentialing of all physicians/providers/ facilities contracted with Essentia HealthActively participates in group leadership meetings and is accountable for presenting credentialing status for all groupsResolve problems, questions, and issues internally, as well as at the payor and the practiceCoordinates and facilitates troubleshooting with payor networks to resolve any issues related to enrollmentsActs as a liaison between Business/Revenue Services, Contracting, EPIC and PayorsEducational Requirements:High School Diploma plus previous work experience or educationRequired Qualifications:2 years’ experience in an office setting, preferably health care, insurance, or business servicesExperience researching issues, thinking critically, learning, and following processes, meeting multiple ongoing deadlines, and interpreting and understanding policies, rules and regulationsExtensive knowledge and experience with Excel, Outlook, Microsoft office products and software programs; shows ability to learn/use software programsExcellent verbal and written communication skills and attention to detailPreferred Qualifications:Experience with payer portals including CMS I&A, PECOS, MPSE, MMIS, Forward Health, CAQH, etc. preferred but not requiredProvider Enrollment Specialist Certificate (PESC) or ability to obtain within 6 months of employment

    Licensure/Certification Qualifications:

    Employee Benefits at Essentia Health: At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Our comprehensive benefits include medical, dental, vision, life, and disability insurance, along with supplemental options to fit your needs. We offer a 401(k) plan with employer contributions to help you plan for the future, and we invest in your professional development through training, tuition reimbursement, and educational programs. To help you thrive both at work and at home, we provide flexible scheduling, generous time off, and wellness resources focused on your physical, mental, and emotional health. Please note that benefit eligibility may vary. For full details, refer to your benefit summary or contact our HR Service Center at (218) 576-0000.

     

    **Job Location:** Support Services Center - Fargo

    **Shift Rotation:** Day Rotation (United States of America)

    **Shift Start/End:** days/days

    **Hours Per Pay Period:** 80

    **Compensation Range:** $21.12 - $31.69 / hour

    Union:

    **FTE:** 1

    Weekends:

    Call Obligations:

    Sign On Bonus:

    It is our policy to afford EEO to all individuals, regardless of race, religion, color, sex, pregnancy, gender identity, national origin, age, disability, family medical history, genetic information, sexual orientation, marital status, military service or veteran status, culture, socio-economic status, status with regard to public assistance, and other factors not related to qualifications, including employees or applicants who inquire about, discuss, or disclose their compensation or the compensation of other employees or applicants, or membership or activity in a local human rights commission, or any other category as defined by law.