Payer Provider Specialist

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Under general supervision, coordinates and manages the payer credentialing processes for Medicare, Medicaid, Medicare Railroad, CAQH and non-delegated providers.

• One year of computer science class, including advanced training in Microsoft Office and other PC-based tools OR Equivalent technical/professional experience
• Associate or bachelor’s degree or equivalent experience

• Not Applicable

• Preferred but not required, one year in a Medical Staff Office or Managed Care Department

• Skill in using computers and navigating various databases
• Ability to stay current with payer database requirements and be subject matter expert
• Skill in oral and written communications
• Ability to work quickly, accurately, and independently
• Ability to develop and maintain effective relationships with a variety of contacts

• Processes provider and facility information for Medicare, Medicaid, Medicare Railroad, CAQH and other non-delegated applications. Reviews applications for completeness, entering data, obtaining appropriate signatures, and forwarding completed applications to providers. Follows up with Practice Managers and/or physicians as needed to obtain signatures. Notifies billing office of completed application and provides necessary provider billing numbers and effective dates.
• Monitors and processes Medicare and Medicaid re-validation applications for timely completion, processing, and distribution of processed application.
• Organizational contact and submitter for MIPS using appropriate online portals. Creates ad-hoc rosters of employed providers for Population Health reporting.
• Represents Managed Care Department at onboarding or other operational meetings. Is key contact for disseminating all provider activity related to credentialing. Works closely with providers, medical staff office, service line managers and practice managers to assist with timely onboarding and processing of providers.
• Reviews documentation for compliance with credentialing requirements. Obtains all credentialing documentation, in correlation with the Medical Staff Office or directly from provider in cases of non-delegation.
• Processes and submits Group or Facility credentialing applications to Medicare and Medicaid. Ensures the entire application is complete and accurate to prevent delay in approval status. Copies, collates, and files applications. Follows up with insurance companies to obtain missing information.
• Maintains working knowledge of Medicare, Medicaid, and CAQH credentialing policies, procedures and online credentialing tools. Including CMS portals such as NPPES, PECOS, and I&A.
• Develops and maintains proficiency with internal tools such as ECHO, EPIC, and Marketware.
• Assists with payer credentialing issues, as necessary.

• Treats others with fairness, kindness, and respect for personal dignity and privacy
• Listens and responds appropriately to others’ needs, feelings, and capabilities

• Meets and/or exceeds customer expectations
• Actively pursues learning and self-development
• Pays attention to detail; follows through

• Sets a positive, professional example for others
• Takes ownership of problems and does what is needed to solve them
• Appropriately plans and utilizes required resources for various job duties
• Reports to work regularly and on time

• Works cooperatively and collaboratively with others for the success of the team
• Addresses and resolves conflict in a positive way
• Seeks out the ideas of others to reach the best solutions
• Acknowledges and celebrates the contribution of others

• Demonstrates honesty, integrity and good judgment
• Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers

• Embraces change and improvement in the work environment
• Continuously seeks to improve the quality of products/services
• Displays flexibility in dealing with new situations or obstacles
• Achieves results on time by focusing on priorities and manages time efficiently

Pay Range: $17.13 - $26.68

Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.

Gilchrist Inova and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

• Entry level

• Full-time

• Other

• Hospitals and Health Care

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