UPMC Corporate Payor Contract Services is hiring a Provider Enrollment Coordinator to join our team in Harrisburg PA! This role will work onsite for the first six months for training and then have flexibility for remote work.

The Provider Enrollment Coordinator is responsible for preparing and submitting enrollment applications and supporting documents for enrolling individual physicians and practices with payers. The Provider Enrollment Coordinator follows up on the status of applications, updates Cactus, and works with the billing and medical staff credentialing office.

Do you have prior experience in payor provider enrollment? If so, this could be the next step in your career. Apply today!

Responsibilities:

• Performs other duties as assigned by Director, Manager and/or Supervisor.
• Maintains archival information related to enrollment.
• Demonstrates knowledge of regulatory issues related to NCQA Standards.
• Performs activities to support and assure policies of Provider Enrollment are met.
• Responsible for day to day activities provider enrollment
• Processes initial and reappointment enrollment applications.
• Reviews applications for completeness and interacts with applicant/office manager to identify and obtain necessary information.
• Interacts with insurance representatives/contacts to identify and obtain necessary information.
• Maintain information within the Cactus software systems. The status of provider enrollment applications must be tracked in Cactus.
• Maintain provider enrollment files electronically via software and shared computer files.
• Management of and creation of initial CAQH profiles (Council for Affordable Quality HealthCare and reattest every 120 days.
• Run expiring provider reports and obtain copies of medical licensures, H1Bs and other required expirables for enrollment and CAQH.
• Initiates mandated queries, both federal and state, for all initial and reappointment for enrollment with the National Practitioner Data Bank (NPDB) and Medicare Opt-out listing.
• Navinet practice and provider updates.
• Runs reports and completes the Medicare and Medicaid revalidations for UPMC Pinnacle outpatient and inpatient providers and practices.
• Resolve issues related to provider participation.
• Review and management of the NPPES data and updates.
• Responsible for interacting with Senior Management, Department Managers, billing staff, medical staff credentialing ect, in order to answer questions and solve billing issues as it relates to the enrollment process.
• Manage the Provider Enrollment mailbox and respond timely and accurately.
• Directory revalidation.
• Notify insurance carriers of new groups, practice changes, removing addresses, updating phone and fax and termination of providers and practices. o Completion of fee assignments.
• Completion of rosters as requested.
• Obtain NPIs for new practices.
• The Provider Enrollment Coordinator assists with all aspects of the insurance provider enrollment process for the organization.
• Enrollment for professional providers to participate in government programs and commercial payer networks.
• The Provider Enrollment Coordinator maintains excellent relations and liaison between payers, clinics and providers to assist in ensuring participation status is managed in a timely and accurate manner.

• Approved Medical Secretary, Associate Degree, or equivalent experience.
• Knowledge of provider enrollment
• Strong interpersonal and organizational skills.
• Knowledge of, and comfort with, multiple software programs.
• Ability to exercise independent judgment.
• Ability to work independently and make sound and timely decisions.

Skills and Abilities:

• Minimum two years enrollment experience preferred.
• Knowledge of provider enrollment.
• Knowledge of regulatory requirements and issues related to role and/or department, such as NCQA, DOH and Joint Commission.

Licensure, Certifications, and Clearances:

• Act 34

UPMC is an Equal Opportunity Employer/Disability/Veteran