Payer Enrollment Specialist
Holy Cross

Employment Type:Full timeShift:Day Shift

Description:
Job Title:

Payer Enrollment Specialist

Employment Type:

Full-Time

Shift:

Days

(SUMMARY) Position Highlights:

• Competitive pay
• Additional Benefits: tuition reimbursement, free parking, employee discounts
• Quality of Life: Flexible work schedules
• Advancement: professional growth within the organization
• Location: Holy Cross Health has two hospitals and four healthcare centers all a short driving distance from Washington DC and Baltimore, MD.

Description:

• Monday-Friday
• The Payer Enrollment Specialist contributes to the overall success of the department by strengthening relationships with insurance payers and physicians meeting department service level expectations. This position will support all comprehensive processes for payer enrollment and re-credentialing, both new and existing physicians and practices.

Responsibilities:

• Responsible for initial payer enrollment and re-credentialing of physicians and midlevel providers as they join the group.
• Creates and updates provider profiles in Verity software including provider registration and generating applications.
• Works with outside billing vendors to ensure enrollment is complete and accurate, coordinating data with NextGen and other system billing applications (internal and external systems)
• Reviews Provider applications and contact providers for any additional documentation or clarification needed. Responsible for maintaining updated Council for Affordable Quality Healthcare (CAQH) online profiles for all providers.
• Maintain basic knowledge of credentialing delegation, requirements, oversight, and industry standard.
• Assist in annual review process for providers to ensure timely payer enrollment pre-assessments, annual audits, file review, analysis, and written evaluation and ongoing follow up as applicable.
• Displays knowledge of insurance and governmental programs, regulations, and billing processes (e.g., Medicare, Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability, etc.), managed care contracts and coordination of benefits.
• Reports to the Director of Professional & Ambulatory Revenue Services

What you will need:

• Associate degree in related field (related experience will be considered in lieu of degree)
• 4 years' work experience, including minimum 2 years' experience in the payer enrollment or Health Care industry.
• Working knowledge of medical terminology, anatomy and physiology, medical record coding (International Classification of Diseases ICD-10, Current Procedural Terminology CPT, Healthcare Common Procedure Coding System HCPCS).
• Ability to critically analyze and apply standards to information submitted by the providers.
• Detail oriented and highly organized.
• Proficiency in Outlook, Word, and Excel.
• Excellent written and oral communication skills.
• Knowledgeable on HIPAA/Confidentiality guidelines.
• Able to manage the pressures associated with setting priorities, handling a large workload, and managing workflow. Able to successfully work in a transparent environment.
• Other duties and responsibilities as deemed necessary according to business needs.
• The incumbent must have a thorough knowledge of various insurance documentation requirements, the patient accounting system, and various data entry codes to ensure proper service documentation and billing of the patient's account.

About us:

Holy Cross Health is a Catholic, not-for-profit health system that serves more than 240,000 individuals each year from Maryland's two largest counties - Montgomery and Prince George's counties. Holy Cross Health earns numerous national awards, clinical designations and accreditations across a wide range of specialties for providing innovative, high-quality health care services.

We were named one of America's 100 Best Hospitals for 2021.

Holy Cross Health is an Equal Employment Opportunity (EEO) employer. Qualified applicants are considered for employment without regard to Minority/Females/disabled/Veteran (M/F/D/V) status

Our Commitment to Diversity and Inclusion

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.

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