COVID-19 Vaccination Information

Across UPMC, our guiding principle is to always prioritize the safety of our employees, patients, and members. UPMC believes that vaccination is important, helps protect all, and advocates that everyone who can be vaccinated should be vaccinated.

UPMC complies with all governmental requirements related to local, state, and federal COVID-19 vaccination for employment. The Jan. 13 Supreme Court of the United States decision that the Centers for Medicare & Medicaid Services federal COVID-19 vaccine mandate will move forward requires UPMC to ensure employees either get vaccinated or receive a requested medical or religious exemption.

If you are not yet vaccinated, we urge you to get a vaccine now. You can schedule your COVID-19 vaccination through UPMC or visit a non-UPMC provider or UPMC Urgent Care location.

Proof of vaccination is not required upon hire; however, employees will be responsible for ensuring post-hire compliance by getting vaccinated or requesting a medical or religious exemption.

For more information about UPMC’s response to COVID-19, please visit UPMC.com/coronavirus.

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   Current UPMC employees must apply in HR Direct

Provider Enrollment Coordinator

  • Job ID: 394837025
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours:
  • Shift: Day Job
  • Facility: Corporate Payor Contract Srvs
  • Department: Payor Contract Services
  • Location: 409 South Second Street, Harrisburg PA 17104
  • Union Position: No
  • Salary Range: $19.86 to $29.82 / hour

Description

UPMC is looking for a Provider Enrollment Coordinator to join their team. This role will be fully on site until fully trained and working independently, then Hybrid. You can also choose to always be on site.

Description
The Provider Enrollment Coordinator is responsible for preparing and submitting enrollment applications and supporting documents for enrolling individual physicians, practices and facilities 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.

Why work at UPMC?

  • At UPMC, we develop strong leaders who support and engage incredible team members. Together, we create an exceptional UPMC Experience for our co-workers and our patients.
  • A recent study showed that UPMC benefits are 20% higher in value than other health care providers in our market. UPMC offers tuition reimbursement, competitive pay, generous paid time off, and much more.
  • AWARD-WINNING WORKPLACE: Ranked #1 for Best Places to Work for Women & Diverse Managers by the Diversity MBA.
  • We have a rewarding career ladder to grow your career with UPMC.


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 retest 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.
  • 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 etc., 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, facilities, practice changes, removing addresses, updating phone and fax and termination of providers and practices.  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 and facilities 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.

 

Qualifications

Qualifications

  • 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.
  • Proficient in Excel

Preferred Knowledge, 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 33 with renewal

Act 34 with renewal

Act 73 FBI Clearance with renewal
UPMC is an Equal Opportunity Employer/Disability/Veteran

Total Rewards

More than just competitive pay and benefits, UPMC’s Total Rewards package cares for you in all areas of life — because we believe that you’re at your best when receiving the support you need: professional, personal, financial, and more.

Our Values

At UPMC, we’re driven by shared values that guide our work and keep us accountable to one another. Our Values of Quality & Safety, Dignity & Respect, Caring & Listening, Responsibility & Integrity, Excellence & Innovation play a vital role in creating a cohesive, positive experience for our employees, patients, health plan members, and community. Ready to join us? Apply today.

   Current UPMC employees must apply in HR Direct

Security Alert

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