The Provider Enrollment/Application Specialist is responsible for preparing and submitting the credentialing application and supporting documentation to enroll individual physicians, locations with payers. This position will collaborate closely with Payer Relations, Patient Accounting, and Managed Care representatives.
Job Relationships
Reports to the Sr. Manager Medical Staff Services.
Principal Responsibilities
Provider Enrollment:
Manage the completion and submission of provider enrollment applications
Provides continued communication with Operations Stakeholders and Managed Care plans to follow up on applications, provider status changes (effective dates/terminations), demographic changes, etc.
Understand specific application requirements for each payer including pre-requisites, forms required, supporting documentation (DEA, license, CV, etc. ) and regulations
Maintain documentation and reporting regarding the enrollment process
Retain records related to completed enrollment applications
Work closely with provider to expedite completion of forms and requirements, including obtaining signatures, locating required documentation, etc.
Maintain provider enrollment information within the credentialing database and on-line required credentialing systems.
Ensure that all credentials files are current and complete according to the expiration date of medical license, board certification, professional liability insurance, DEA, and other pertinent information as required by Client and Client's third-party entities (facilities, payers, etc.)
Process applications for providers for re-credentialing with facilities and payers
Collaborate with Patient Accounting and Payer Relations to ensure proper compliance with payers' credentialing requirements.
Identifies recurring credentialing issues to discuss during regular payer relations meetings, provides appropriate follow-up and documentation as necessary.
Maintains a positive and professional relationship with all providers, field questions, and collects data, interacts consistently with various departments.
Application Administrator:
Maintain managed care module in MD Staff.
Develop and maintain MCO dashboards, database queries/reports.
Provide user support to Payer Relations for MD Staff.
Comply with the Springfield Clinic incident reporting policy and procedures.
Adhere to all OSHA and Springfield Clinic training & accomplishments as required per policy.
Provide excellent customer service and adhere to Springfield Clinic's Code of Conduct and Ethics Standards.
Perform other job duties as assigned.
Education/Experience
Bachelor's degrees in business or related field required or three - five (3-5) years of related expereince required.
Knowledge, Skills and Abilities
Knowledge of commercial credentialing policies and applicable government regulations and standards, and the ability to actively apply that knowledge in the performance of all job duties.
Familiarity with private and commercial insurance carriers, including Medicare and Medicaid.
Proficient in all Microsoft Office tools, including Excel, Access, PowerPoint, and Word.
Ability to manage multiple tasks and work in a fast-paced environment.
Detail-oriented and able to deliver a high level of accuracy.
Strong communication skills.
Ability to recognize a problem and effectively problem-solve, accessing guidance from other resources when necessary.
Working Environment
Requires sitting for long periods of time.
Office environment.
PHI/Privacy Level
HIPAA4
•
United States - IL - IL - Worth
April 23, 2024
Great Pay Consistent Miles • 24/7 Recruiters Available! • Earn GREAT PAY, consistent miles 24/7 support! Solo Drivers: 2,220+ Miles Per Week On Average and GREAT PAY! • Team Drivers: Up to $15,000 Sign-On Bonus/split with an average of 5,500 miles per week! Interested in a 30 days out/28 days home...
United States - IL - IL - Oak Park
May 19, 2024
Sears Holdings - JobID: • 83691271 [Auto Service Technician] As a Service Technician at Sears, you'll: • Improve and maintain customer service response time; Monitor/inspect new installs to insure products and services provided are to company standards; Write up service work orders;...
United States - IL - IL - Elk Grove Village
May 25, 2024
• Position Summary: • • The Senior Software Engineer position involves taking a lead role in the design, implementation, configuration, and maintenance of enterprise supply management applications. This requires a seasoned professional proficient in Java, Angular, Microservices, Micro Front Ends,...
United States - IL - IL - Downers Grove
May 1, 2024
Diesel Technicians Keep Us Rolling We understand the value of team and the crucial role each department plays in Hirschbach's success. Our skilled diesel technicians keep our fleet of 2,000+ truck rolling safely and ensure we operate at the level that our customers expect. Empowering Your Career If...
United States - IL - IL - Arlington Heights
March 25, 2024
CDL-A DEDICATED COMPANY TRUCK DRIVERS OPPORTUNITIES • SIGN ON BONUSES MAY BE AVAILABLE! • DEDICATED DRIVERS: Choose U.S. Xpress.Great Home Time & Pay: Earn up to $70,000+ annually! Call and ask for details of routes available in your area. • Benefits: • Home time varies per location • Unloading and...
United States - IL - IL - Madison
May 30, 2024
LEGENDS • Founded in 2008, Legends' operating divisions worldwide include - Global Partnerships, Global Sales, Hospitality, Global Partnerships, Global Merchandise, Global Technology Solutions, Attractions, Growth Enterprises - offering clients and partners a 360-degree data and analytics fueled...
United States - IL - IL - River Forest
April 23, 2024
Great Pay Consistent Miles • 24/7 Recruiters Available! • Earn GREAT PAY, consistent miles 24/7 support! Solo Drivers: 2,220+ Miles Per Week On Average and GREAT PAY! • Team Drivers: Up to $15,000 Sign-On Bonus/split with an average of 5,500 miles per week! Interested in a 30 days out/28 days home...
United States - IL - IL - Midlothian
April 23, 2024
Great Pay Consistent Miles • 24/7 Recruiters Available! • Earn GREAT PAY, consistent miles 24/7 support! Solo Drivers: 2,220+ Miles Per Week On Average and GREAT PAY! • Team Drivers: Up to $15,000 Sign-On Bonus/split with an average of 5,500 miles per week! Interested in a 30 days out/28 days home...
United States - IL - IL - Cornland
May 30, 2024
Location Gerald, MO Hiring Company End Dump DriversIf you are an experienced end dump driver or if you are an experienced truck driver who would like to learn end dumping we want to talk to you. • Come drive a 4 year old or newer Peterbilt 579 geared toward your comfort while on the road....
United States - IL - IL - Lincoln
May 23, 2024
To Apply for this Job POSITION: Behavioral Health Technician • SCHEDULE: 12p-8 p, Monday-Friday (Sat/Sun off) • FACILITY: Logan Correctional Center • LOCATION: Lincoln, Illinois • 23.98 Starting Rate • A Job Should beMORE than just a paycheck.Wexford Health Sources, Inc.is one of the nation's...
United States - IL - IL - Batavia
May 1, 2024
Diesel Technicians Keep Us Rolling We understand the value of team and the crucial role each department plays in Hirschbach's success. Our skilled diesel technicians keep our fleet of 2,000+ truck rolling safely and ensure we operate at the level that our customers expect. Empowering Your Career If...
United States - IL - IL - Riverdale
April 23, 2024
Great Pay Consistent Miles • 24/7 Recruiters Available! • Earn GREAT PAY, consistent miles 24/7 support! Solo Drivers: 2,220+ Miles Per Week On Average and GREAT PAY! • Team Drivers: Up to $15,000 Sign-On Bonus/split with an average of 5,500 miles per week! Interested in a 30 days out/28 days home...
United States - IL - IL - Frankfort
March 25, 2024
CDL-A DEDICATED COMPANY TRUCK DRIVERS OPPORTUNITIES • SIGN ON BONUSES MAY BE AVAILABLE! • DEDICATED DRIVERS: Choose U.S. Xpress.Great Home Time & Pay: Earn up to $70,000+ annually! Call and ask for details of routes available in your area. • Benefits: • Home time varies per location • Unloading and...
United States - IL - IL - Alsip
May 2, 2024
Jewel-Osco - JobID: • 468655 [Grocery Clerk / Team Member] As a Deli Associate at Jewel-Osco, you'll: • Operate computerized cash register and electronic scale in store delicatessen to weigh, wrap, itemize, and total customer's purchases; Take deli orders face to face or by telephone;...
United States - IL - IL - Wood Dale
May 30, 2024
Located in Chicago O'Hare International AirportWE ARE OFFERING A $300 HIRING BONUS FOR JOINING OUR TEAM!Grow With Us!Hudson is North America's leading travel retailer. • For over 30 years, Hudson has met the needs and wants of travelers in more than 1,000 duty-free, duty-paid, and food & beverage...
United States - IL - IL - Carol Stream
May 1, 2024
Diesel Technicians Keep Us Rolling We understand the value of team and the crucial role each department plays in Hirschbach's success. Our skilled diesel technicians keep our fleet of 2,000+ truck rolling safely and ensure we operate at the level that our customers expect. Empowering Your Career If...
United States - IL - IL - Hanover
May 14, 2024
Hiring Local CDL-A Drivers • Grow your career with an industry leader! • We are Prairie Farms, and we are proud to be comprised of more than 800 farm families throughout the Midwest. Since 1938, we have been producing high quality products and providing fresh, safe and nutritious milk to...
United States - IL - IL - Chicago
March 25, 2024
CDL-A DEDICATED COMPANY TRUCK DRIVERS OPPORTUNITIES • SIGN ON BONUSES MAY BE AVAILABLE! • DEDICATED DRIVERS: Choose U.S. Xpress.Great Home Time & Pay: Earn up to $70,000+ annually! Call and ask for details of routes available in your area. • Benefits: • Home time varies per location • Unloading and...
United States - IL - IL - Dolton
April 23, 2024
Great Pay Consistent Miles • 24/7 Recruiters Available! • Earn GREAT PAY, consistent miles 24/7 support! Solo Drivers: 2,220+ Miles Per Week On Average and GREAT PAY! • Team Drivers: Up to $15,000 Sign-On Bonus/split with an average of 5,500 miles per week! Interested in a 30 days out/28 days home...
United States - IL - IL - Addison
May 1, 2024
Diesel Technicians Keep Us Rolling We understand the value of team and the crucial role each department plays in Hirschbach's success. Our skilled diesel technicians keep our fleet of 2,000+ truck rolling safely and ensure we operate at the level that our customers expect. Empowering Your Career If...
United States - IL - IL - La Grange Park
April 23, 2024
Great Pay Consistent Miles • 24/7 Recruiters Available! • Earn GREAT PAY, consistent miles 24/7 support! Solo Drivers: 2,220+ Miles Per Week On Average and GREAT PAY! • Team Drivers: Up to $15,000 Sign-On Bonus/split with an average of 5,500 miles per week! Interested in a 30 days out/28 days home...
United States - IL - IL - Westmont
May 1, 2024
Diesel Technicians Keep Us Rolling We understand the value of team and the crucial role each department plays in Hirschbach's success. Our skilled diesel technicians keep our fleet of 2,000+ truck rolling safely and ensure we operate at the level that our customers expect. Empowering Your Career If...
United States - IL - IL - Waukegan
March 25, 2024
CDL-A Dedicated Truck Driver: $1,000 Weekly Minimum! • Drive 12 days and get home 2 days • LIMITEDTIME! U.S. Xpress is now hiring for one of our most popular dedicated lanes with $1,000 Weekly Minimum! No touch freight! USX offersgreat benefits! Only 3 months experience required. • Benefits: •...
United States - IL - IL - Vandalia
May 28, 2024
IBEW Local 146 is looking for skilled Electricians to add to our rapidly growing industry. Duties and Responsibilities: • • Maintenance • Repair • Installation of primarily commercial and industrial electrical systems Qualifications: • • 3+ years of experience preferred Benefits and Pay: • • Receive...
United States - IL - IL - Urbana
March 29, 2024
Merry Maids - JobID: • 100-#25 [Cleaner / Room Attendant] As a Housekeeper at Merry Maids, you'll: • Use cleaning products and procedures to clean, dust cobwebs, clean all hanging light fixtures and dust baseboards and window sills each cleaning; Use cleaning products and procedures to...
United States - IL - IL - Lake Forest
May 30, 2024
A Day in the Life: • Our sales and store support teams, also known as clerks in the grocery world, play an important part in ensuring our stores are clean, organized, and shoppable so that our customers can find exactly what they need to keep their families healthy and fed. In this role, you are the...
United States - IL - IL - Wheeling
May 30, 2024
Located in Chicago O'Hare International Airport • WE ARE OFFERING A $300 HIRING BONUS FOR JOINING OUR TEAM!Grow With Us! • Hudson is North America's leading travel retailer. For over 30 years, Hudson has met the needs and wants of travelers in more than 1,000 duty-free, duty-paid, and food &...