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Alameda Health System: Medical Staff Provider Enrollment Coordinator

Alameda Health System

This is a Contract position in Gracie Square, NY posted January 10, 2022.

SUMMARY: Responsible for enrolling new and established AHS healthcare employed and contracted providers with all types of health plans including federal and state government agencies/programs and private healthcare insurers; maintains the initial enrollment, revalidation, and termination of health plan provider participation.DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification.

However, employees may perform other related duties at an equivalent level.

Not all duties listed are necessarily performed by each individual in the classification.1.

Maintains the database including but not limited to data entry, scanning documents and maintaining data sufficient to pre-populate applications supported by the database.2.

Works with payers to facilitate issue resolution, re-enrollment, and termination requirements.3.

Coordinates responses to inquiries regarding payer’s applications; follows up with each payer and or provider to completion; assesses provider credentialing files to determine if additional information is required; revisits state and federal bulletins for provider sanctions.4.

Facilitates, completes, maintains the enrollment application process for all employed and contracted AHS healthcare providers (medical doctors and advance practice providers) with the various commercial, managed care, and governmental payors.5.

Maintains AHS provider enrollment database in applicable AHS computer system(s).6.

Maintains provider CAQH profiles.7.

Initiates enrollment application process, including pre-requisites, forms, and formats, form completion requirements, supporting documentation, and other requirements.8.

Coordinates responses to inquiries regarding enrollment inquiries.9 Corresponds with providers, staff, and network provider relations staff to coordinate/confirm network provider participation; communicates to internal and external customers’ provider enrollment information and status.10.

Interacts with Administration, Medical Staff, and Billing to address and resolve issues and opportunities for system and relationship improvements.11.

Completes dis-enrollments, notifies health plans of termination/resignations.12.

Reviews and processes mail and/or interdepartmental correspondence as received.13.

Works with Risk Management Department and insurance carriers regarding malpractice insurance renewals; sends copies to top payors as needed.14.

Participates in surveys by regulatory bodies (TJC, NCQA, CMS, federal and state) and health plan audits.15.

Performs other duties as required.MINIMUM QUALIFICATIONS:Required Education: High School Diploma or G.E.D.Required Experience: Two years Medical Staff Services and/or Health Plan credentialing experience.Preferred Experience: Provider credentialing and/or enrollment with health plan insurers.System Support CenterMedical Staff OfficeServices As Needed / Per DiemDayAdmin, Business & Clinical SupportFTE: 0.01