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Credentialing Specialist - Provider Enrollment

Requisition ID:

19161010

Business Unit:

Hartford HealthCare Corp.

Location:

Hartford, CT

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Description

Job Schedule: Full Time
Standard Hours: 40
Job Shift: Shift 1
Shift Details:

Work where every moment matters.
 
Every day, almost 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here.  We invite you to become part of Connecticut’s most comprehensive healthcare network. 

 The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization.

With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.

Position Summary:

Carries out the provider enrollment function as delegated by payor plans and ICP. Completes accurate and timely payor enrollments applications and coordinates workflow for applications in the queue, assigning work to the Credentialing Associate. Maintains the Provider Enrollment database and external databases. Secures documents for primary source verification. Produces and replies to general correspondence. Assures revalidation of providers with various payors in a timely manner. Interacts with representatives from health plans. Acts as a subject matter expert and internal consultant to various functions within HHC concerning provider enrollment. Coaches and mentors the Credentialing Associate. Provides guidance to providers on their enrollment, and on CAQH database updates.

Requirements:

  1. Processing provider applications to all health plans. Abstracting pertinent data from the Universal application to HHC CVO, and completing payor specific enrollment documents to assure claims acceptance. Processing and tracking of applications to ensure timely enrollment, and providing PFS and revenue department with provider ID numbers for claims processing.
  2. Carrying out Primary Source Verification. Accessing external databases to obtain primary source documents necessary to complete payor applications in accordance with delegated credentialing agreements, CVO policy and accrediting standards. 
  3. Maintaining the provider enrollment database. Updating the database with new providers, and with changes in provider information. Suggesting updates to the application to improve efficiency. 
  4. Document Management. Assures current versions of forms used for the provider enrollment function are being used, and integrates the forms into the electronic application by collaborating with the IT specialist on form design. 
  5. Correspondence: Generating and replying to correspondence related to provider enrollment. 
  6. Interaction with representatives from health plans to answer inquiries, clarify requirements.
  7. Contributing to team performance through collaboration on tasks, participation in H3W and other staff meetings, huddles, etc. Informs leadership of work
  8. Subject Matter Expert and Internal consultant on provider enrollment. Collaborates with various departments and functions affected by the enrollment process (PFS, Medical Staff Offices, ICP, Medical staff onboarding, etc.) 
  9. Facilitation of Provider application process: Meets with Providers to assist them in filling out the necessary applications. Provides them guidance with regard to payor requirements, CAQH maintenance, timelines, etc
  10. Providing Guidance to the Credentialing Associate: delegates work to be done, prioritizes the queue, and coaches with regard to requirements, standards, policy and deadlines. 
  11. Collaborates with the payor contracting function to learn payor requirements and incorporate them into the enrollment process.

 

 

Qualifications

  • Associate Degree required, Bachelors Degree preferred
  • 3 - 5 years experience in an administrative support capacity in healthcare at the advanced level required; 5 years experience working within the insurance agency, hospital or other healthcare setting with responsibilities related to credentialing or provider enrollment preferred
  • CPCS or willing to obtain within two years.
  • Understanding of the credentialing and privileging process for health plans
  • Computer Proficiency
  • Microsoft Office to include Word, Excel, Power Point
  • Ability to work with an application specific database
  • Working knowledge of medical terminology
  • Excellent interpersonal skills
  • Customer service orientation 
  • Ability to work well within a team structure.
  • Attention to detail
  • Ability to work with multiple projects and deadlines
  • Strong analytical skills
  • Knowledge of NCQA and delegated credentialing requirements.

 

 
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