Job Summary
Oversees the internal processes and procedures as well as Governmental, and regulatory requirements for the timely and accurate completion and submission of provider applications. Assists in departmental planning, development, and organization. Responsible for the timely, accurate, and compliant enrollment of Atrium Health providers with government payers, as well as the timely and accurate processing, follow up, and verification of completion of applications for participation in Medicare (NC/SC), NC Medicaid (NCTracks), SC Medicaid programs for AH providers and physician groups. The position is responsible for ensuring that the credentialing and enrollment functions are completed in compliance with all Atrium Health, CMS, State and national accrediting agency(s) standards.
Essential Functions
- Performs primary source verifications of documentation required for managed care credentialing and re-credentialing of MGD providers.
- Provides issue resolution and support regarding billing issues as they relate to provider enrollment and credentialing for MGD providers and the Central Billing Office.
- Enters provider data in the ECHO database according to established departmental processes and provides feedback to other System entities as to the status of the applicants.
- Performs follow-up on needed information (expired licenses, board certifications insurance and DEA registrations) on an ongoing basis and ensures receipt of same in a timely manner.
- Prepares physician files for file audits by managed care organizations, Corporate Compliance and accreditation entities.
- Conducts practice site visits for practices within MGD. Facilitates communication tools and or activities to maintain timely and accurate flow of information to Managed Care Organizations (MCOs) and the System.
- Reviews hard copy and electronic provider directories and other information produced by managed care organizations reflecting MGD and the System’s demographics and participation.
- Provides Team member support to the CPN Credentialing and Quality Review Committee.
- Accurately and clearly documents process steps, dates, and work status in the MOAD system.
- Answers departmental telephone and emails, routes to appropriate staff and takes accurate messages as needed. Commits to return all phone and email inquiries within 24 hours even if not resolved.
- Independently processes and submits complete, timely and accurate enrollment applications to The Center for Medicare Services (CMS) and state Medicaid offices on behalf of new groups and currently employed Atrium Health Medical Group (AHMG) providers and groups billing under AH MG tax ID numbers.
- Promotes and assists in the smooth, efficient delivery of departmental services to providers, AH MG, AH, and other corporate departments and outside agencies.
Physical Requirements
Perform most duties under normal office conditions which may include sitting for long periods of time, standing, walking, using repetitive wrist/arm motion or lifting articles 20-50 pounds. Work is subject to time sensitivity, heavy volumes, and frequent interruptions, either by phone or other employees. Must use frequent and variable body movements during filing and maintaining records. Require frequent verbal and written communication in English to employees, corporate staff, providers, and external agencies. Require occasional travel to other corporate offices. Use of personal vehicle required. Intact sense of sight and hearing required.
Education, Experience and Certifications
High school diploma or GED required; Bachelor's degree preferred. Three years’ experience in a role that performs or supports provider credentialing, privileging, and/or enrollment in either a hospital, managed care plan or CMS environment is required. Knowledge of and experience with personal computers, Windows and Microsoft applications, copier and fax machines and multi-line telephone required. Experience in typing, word processing, and business correspondence is required. Certification through National Association of Medical Staff Services (NAMSS) as Certified Provider Credential Specialist (CPCS) or Professional Medical Services Management (CPMSM) preferred.
Atrium Health is one of the nation’s leading healthcare organizations, connecting patients with on-demand care, world-class specialists and the region’s largest primary care network. A recognized leader in healthcare delivery, quality and innovation, our foundation rests on providing clinically excellent and compassionate care.
We’ve been serving our community since 1940, when we opened our doors as Charlotte Memorial Hospital. Since then, our network has grown to include more than 40 hospitals and 900 care locations ranging from doctors’ offices to behavioral health centers to nursing homes.
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