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   Current UPMC employees must apply in HR Direct

Provider Enrollment Coord

  • Job ID: 934970628
  • Status: Full-Time
  • Regular/Temporary: Regular
  • Hours: 8 a.m. to 4:30 p.m.
  • Shift: Day Job
  • Facility: UPMC Pinnacle
  • Department: Provider Enrollment
  • Location: 409 South Second Street, Harrisburg PA 17104
  • Union Position: No
  • Salary Range: $19.29 to $28.95 / hour

Description

Purpose:
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.

Responsibilities:

  • 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 liaisons between payers, clinics and providers to assist in ensuring participation status is managed in a timely and accurate manner.
  • 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.  Manage the Provider Enrollment mailbox and respond timely and accurately. Resolve issues related to provider participation.
  • Responsible for interacting with Senior Management, Department Managers, billing staff, medical staff credentialing etc, in order to answer questions and solve billing issues as it relates to the enrollment process.
  • Reviews applications for completeness and interacts with applicant/office manager to identify and obtain necessary information.  Processes initial and reappointment enrollment applications. Obtain NPIs for new practices.
  • Interacts with insurance representatives/contacts to identify and obtain necessary information.  Notify insurance carriers of new groups, practice changes, removing addresses, updating phone and fax and termination of providers and practices.
  • 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.
  • Review and management of the NPPES data and updates.
  • 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.

 

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.

Preferred Knowledge, Skills, and Abilities:

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


Licensure, Certifications, and Clearances:
Clearances must be dated within 90 days
 

  • 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