Enrollment Specialist

Current Employees:

(Determined by the knowledge, skills, and experience of the applicant.)

Monument Health offers competitive wages and benefits on qualifying positions. Some of those benefits can include:

*Supportive work culture

*Medical, Vision and Dental Coverage

*Retirement Plans, Health Savings Account, and Flexible Spending Account

*Instant pay is available for qualifying positions

*Paid Time Off Accrual Bank

*Opportunities for growth and advancement

*Tuition assistance/reimbursement

*Excellent pay differentials on qualifying positions

*Flexible scheduling

Essential Functions:

• Directly responsible for oversight and collection of accurate credentialing of organizational providers, facilities and ancillary services.
• Oversight and collection of documentation necessary for payer enrollment of complex hospital groups and services compliant with hospital system policies and accreditation sources such as NCQA, CMS and others.
• Ensure compliance with applicable regulatory requirements, accreditation standards, payer policies, and governing documents.
• Obtain application signatures from the authorized signatory and provide all required supporting documentation. Submit applications and follow up diligently to ensure timely processing. Respond to deficiency notifications in a timely manner. Follow up diligently on provider addition requests and communicate provider changes, corrections, and terminations. Continuously monitor enrollment process for improvements. Collaborate with Legal and Accreditation to ensure regulatory and compliance requirements are met.
• Responsible for delegated credentialing policy interpretation and compliance. Responsible for annual payor credentialing file audits. Oversees delegated credentialing roster submission and tracking. Work with delegated payer contacts to address concerns within the delegation process while cultivating relationship with delegated payers.
• Works collaboratively with Medical Staff Services team to promote data integrity and to optimize effectiveness of the Credentialing database, ensuring consistency in data entry rules. Supports the implementation of new database modules applicable to Medical Staff Services. Implementation includes data migration and validation, as well as data mapping to demographic reports, participation reports, and training.
• Provides training related to payer enrollment that enhances knowledge, develop skills and enrich the team.
• Excellent interpersonal skills and ability to work efficiently with internal and external customers. Maintain positive working relationships with payer representatives, providers, and all Monument Health internal departments.
• All other duties as assigned.

Required:

Education - High School Diploma/GED Equivalent in General Studies

Experience – Minimum 1 year of healthcare experience (i.e. Credentialing/Enrollment, Billing/Collections, Business Office)

Preferred:

Education - Associates or Bachelor’s degree in Healthcare or Business

Requires the ability to work assigned schedules and hours as determined by the department

Make a difference.  Every day.

Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.