Edtech.com's Summary

Oregon Health & Science University is hiring a Provider Enrollment Coordinator. The role involves enrolling practitioners and facilities with government and insurance carriers, maintaining active billing status, and ensuring compliance with regulatory and contractual requirements. The coordinator collaborates with various departments to achieve accurate credentialing, handles data entry in provider enrollment systems, and manages provider documentation and audits.

Highlights

Enroll OHSU-affiliated practitioners and facilities with government and commercial payers.
Utilize health information systems and multiple enrollment platforms like NPPES, PECOS, and Medicaid Management Information System.
Maintain provider documentation, licensure, and facilitate payer re-credentialing and revalidations.
Collaborate closely with OHSU Medical Affairs, departments, and partners to ensure compliance and timely billing status.
Troubleshoot claims in EPIC work queues and maintain relations with insurance carriers.
Develop workflows and participate in claims correction and LEAN process improvement projects.
Required qualifications include a high school diploma plus 2 years in healthcare billing/insurance or an associate's degree plus 1 year experience.
Proficiency with Microsoft Office and healthcare information systems is necessary.
Knowledge of government and commercial insurance regulations, HIPAA, and managed care contracts required.
Compensation range: $26.09 - $35.28 per hour, dependent on experience and education.

Provider Enrollment Coordinator (Enrollment Coordinator) Full Description

Department Overview:

The Enrollment Coordinator is responsible for enrolling OHSU Practice Plan practitioners, OHSU affiliated practitioners, OHSU facilities, and OHSU Partners’ facilities with government and insurance carriers; and is responsible to initiate and maintain active billing status in accordance with organizational policies and procedures, regulatory requirements and contracts for governmental and commercial payers, and Medical Staff Bylaws.

Function/Duties of Position:

Enrollment Process

Utilize Health Information Systems to analyze and investigate practitioner information, and distribute provider credentialing and enrollment packets in coordination with OHSU Medical Affairs Program, meeting established policies and procedures.
Prepare and distribute practitioner and facility data, complying with the requirements outlined by state government, federal government, and commercial carriers.
Perform data entry of sensitive provider information in federal and state provider enrollment systems.
This process requires knowledge of legal, federal, state, and OHSU requirements; the National Plan and Provider Enumeration System (NPPES); the Medicaid Management Information System (MMIS); licensing boards; MSOW; the Oregon Practitioner Credentialing Application (OPCA); the Provider Enrollment Chain and Ownership System (PECOS); the CMS Identity and Access Management System; and, Washington’s ProviderOne.
Collaborate with OHSU Medical Affairs Program, OHSU departments and OHSU Partners to achieve accurate credentialing, timely enrollment, and compliant billing status. Troubleshoot problem claims in EPIC work queues.
Maintain positive relations with insurance carriers to assist with timely reimbursement, problem solving, and plan participation.
Perform timely annual enrollment and termination of residents and fellows.

File Maintenance

Collect and maintain appropriate provider documentation and licensure, perform manual enrollment processes, and facilitate practitioner payer re-credentialing and revalidations. Update and maintain practitioner and facility database as a central resource for OHSU, OHSU Health Plan and OHSU partners, including department and billing personnel.
Document, maintain and understand regulatory requirements for governmental and commercial payers.

Audits and Special Projects

Develop and update necessary workflows and documentation relevant to provider enrollment to improve effectiveness of department operations.
Provide ad hoc reporting based on need or request. Participate in special claims correction projects related to enrollment.
Promote and implement LEAN processes.
Perform other duties as assigned.

Required Qualifications:

High School Diploma or equivalent required, AND 2 years in health care, medical billing and/or insurance environment. Experience with provider enrollment or insurance credentialing, including knowledge of governmental and commercial insurance and HIPAA regulations, and understanding of managed care contract policies in a health care or insurance carrier setting required; OR
Associate's degree and 1 years’ experience health care and/or health insurance; OR
A combination of education and experience.
Demonstrated software database experience (for efficient generation of letters and other correspondence, activity tracking and report production).
Demonstrated ability to work with a diverse team and customer base, using excellent communication skills, listening, verbal, and written.
Strong organizational skills, accurate data entry, and the ability to multi-task.
Proficiency with standard office equipment and software such as Microsoft Office.
Knowledge of health care information systems.
Familiarity with legal, state, and health care insurance guidelines, assuring compliance with regulatory agencies.

Additional Details:
Benefits

Healthcare for full-time employees covered 100% and 88% for dependents.
$50K of term life insurance provided at no cost to the employee.
Two separate above market pension plans to choose from.
Vacation - up to 200 hours per year dependent on length of service.
Sick Leave - up to 96 hours per year.
9 paid holidays per year.
Substantial Tri-Met and C-Tran discounts.
Employee Assistance Program.
Childcare service discounts.
Tuition reimbursement.
Employee discounts to local and national businesses.

Why apply to OHSU?: We are Oregon's only public academic health center. In addition to caring for patients, we lead groundbreaking research. We also train the next generation of health care professionals. As Portland's largest employer, we give you opportunities to learn and advance in a system of hospitals and clinics across Oregon and Southwest Washington. All are welcome. OHSU welcomes people of all ages, ethnicities, genders, national origins, religions and sexual orientations. We are striving to build an anti-racist, multicultural institution and encourage people with diverse backgrounds to apply. To request reasonable accommodation, contact askhr@ohsu.edu

Original Job Description

Department Overview:

Enrollment Process

Utilize Health Information Systems to analyze and investigate practitioner information, and distribute provider credentialing and enrollment packets in coordination with OHSU Medical Affairs Program, meeting established policies and procedures.
Prepare and distribute practitioner and facility data, complying with the requirements outlined by state government, federal government, and commercial carriers.
Perform data entry of sensitive provider information in federal and state provider enrollment systems.
This process requires knowledge of legal, federal, state, and OHSU requirements; the National Plan and Provider Enumeration System (NPPES); the Medicaid Management Information System (MMIS); licensing boards; MSOW; the Oregon Practitioner Credentialing Application (OPCA); the Provider Enrollment Chain and Ownership System (PECOS); the CMS Identity and Access Management System; and, Washington’s ProviderOne.
Collaborate with OHSU Medical Affairs Program, OHSU departments and OHSU Partners to achieve accurate credentialing, timely enrollment, and compliant billing status. Troubleshoot problem claims in EPIC work queues.
Maintain positive relations with insurance carriers to assist with timely reimbursement, problem solving, and plan participation.
Perform timely annual enrollment and termination of residents and fellows.

File Maintenance

Collect and maintain appropriate provider documentation and licensure, perform manual enrollment processes, and facilitate practitioner payer re-credentialing and revalidations. Update and maintain practitioner and facility database as a central resource for OHSU, OHSU Health Plan and OHSU partners, including department and billing personnel.
Document, maintain and understand regulatory requirements for governmental and commercial payers.

Audits and Special Projects

Develop and update necessary workflows and documentation relevant to provider enrollment to improve effectiveness of department operations.
Provide ad hoc reporting based on need or request. Participate in special claims correction projects related to enrollment.
Promote and implement LEAN processes.
Perform other duties as assigned.

Required Qualifications:

High School Diploma or equivalent required, AND 2 years in health care, medical billing and/or insurance environment. Experience with provider enrollment or insurance credentialing, including knowledge of governmental and commercial insurance and HIPAA regulations, and understanding of managed care contract policies in a health care or insurance carrier setting required; OR
Associate's degree and 1 years’ experience health care and/or health insurance; OR
A combination of education and experience.
Demonstrated software database experience (for efficient generation of letters and other correspondence, activity tracking and report production).
Demonstrated ability to work with a diverse team and customer base, using excellent communication skills, listening, verbal, and written.
Strong organizational skills, accurate data entry, and the ability to multi-task.
Proficiency with standard office equipment and software such as Microsoft Office.
Knowledge of health care information systems.
Familiarity with legal, state, and health care insurance guidelines, assuring compliance with regulatory agencies.

Additional Details:
Benefits

Healthcare for full-time employees covered 100% and 88% for dependents.
$50K of term life insurance provided at no cost to the employee.
Two separate above market pension plans to choose from.
Vacation - up to 200 hours per year dependent on length of service.
Sick Leave - up to 96 hours per year.
9 paid holidays per year.
Substantial Tri-Met and C-Tran discounts.
Employee Assistance Program.
Childcare service discounts.
Tuition reimbursement.
Employee discounts to local and national businesses.

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Provider Enrollment Coordinator (Enrollment Coordinator)

Edtech.com's Summary

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