Credentialing Payer Specialist

• DEPARTMENT: 68221 - Business Office NCHHG
• LOCATION:
  
  1100 Immokalee Road, Naples, FL, 34110
• WORK TYPE:
  Full Time
• WORK SCHEDULE:
  
  8 Hour Day

NCH is an independent, locally governed non‑profit delivering premier comprehensive care. Our healthcare system is comprised of two hospitals, an alliance of 700+ physicians, and medical facilities in dozens of locations throughout Southwest Florida that offer nationally recognized, quality health care.

NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to:
Provide higher acuity care and Centers of Excellence;
Offer Graduate Medical Education and fellowships;
Have endowed chairs;
Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and Pro Scan.

Join our mission to help everyone live a longer, happier, healthier life. We are committed to care and believe there's always more at NCH - for you and every person we serve together. Visit nchjobs.org to learn more.

The Credentialing Payer Specialist coordinates, manages, and facilitates all required provider enrollment activities for the NCH Physician Group Revenue Cycle Department for participation with all government and third‑party payers. The Credentialing Payer Specialist acts as liaison with the NCH Health System Physicians Services, Contract Management and others facilitating communication between the departments, providers, and payers when necessary, ensuring all required documentation is received timely.

Promotes and enhances good communication and positive working relationships between the Physician Group and the Medical Staff. Above all, this position serves to exceed the expectations of patients and all other customers we serve.

Other duties may be assigned.

• Coordinates and provides administrative support for the payer credentialing process (initial provider enrollment and re‑enrollment).
• Initiates credentialing and provider enrollment activities in a timely, comprehensive, and well‑organized manner, per established policies and procedures.
• Upon receipt of a completed initial provider enrollment application, coordinates information collection, verification, and documentation, enters data in the physician profiling data base per established policies and procedures.
• Facilitates on‑boarding efforts through collaboration with Recruitment, Medical Staff, Human Resources, and additional departments as needed.
• Coordinates and facilitates gathering required documentation in order to successfully process and enroll providers with third party payers, obtain staff privileges, and obtain malpractice insurance as needed. Work closely with the appropriate leadership, departments, and staff to complete the processes.
• Closely monitors information collection, makes cognitive analysis of all information received, appropriately evaluating the quality of the documentation received, pursuing additional information, if necessary, for effective, comprehensive, and successful provider enrollment.
• Immediately reports to Senior Director of Revenue Cycle, Assistant Director of Revenue Cycle, and the Medical Staff Services office, all information which is averse to the provider enrollment application(s) (I.E. credentialing issues, adverse letters, gaps on application, peer review recommendations, disciplinary actions, etc.).
• Performs timely follow up for all outstanding provider enrollment applications and contracts.
• Prepares a weekly status report to send to management and designated staff providing updated status of all pending applications and tasks.
• Plans, develops, and provides for supporting provider enrollment documentation for NCH Physician Group departments/committee meetings.
• Attends meetings, prepares, and maintains accurate minutes, and processes follow up needs to facilitate effective provider enrollment, documentation, communication and otherwise maintains all necessary filing for assigned meetings ensuring minutes are completed within two weeks of meeting dates.
• Monitors department/committee activities to identify and address provider…