Delegate Credentialing Provider Enrollment Coordinator

University of Virginia • Charlottesville, VA • 13h ago

This position will assist in complying with all delegated credentialing and enrollment processes to maintain provider eligibility to bill Medicare/Medicaid/Department of Defense and managed care payors for the provision of professional health care services. Such functions include enrollment of all new physicians with government and managed care payors. In addition, this position will work to ensure employment agreements are renewed timely in an effort to eliminate delays with professional billing.

Handles enrollment information for Medicare and Medicaid to ensure the highest level of accuracy.

Completes enrollment process including provider enrollment activities by completing applications for all Medicare and Medicaid, including tracking of such applications until the provider numbers are issued.

Works with Insurance Processing Unit departments in Billing and Collections by working Departmental requests on provider issue denials.

Works with payors on changes, such as address changes to both physical location and payment address, name changes, etc.

Responsible for creation of Professional Billing Spreadsheet and forwards to EPIC PB Team of all new physicians and allied health professionals being issued privileges, as well as changes to existing physicians/allied health professionals entry providers once privileges are issued/changed or terminated. Authorizes any updates to the provider professional billing record in EPIC.

Coordinates leased professional providers in collaboration with Legal, HR and Clinical Staff Offices to allow for timely enrollment in all health care plans contracts, to enable to the Health System to bill and collect professional services on their behalf.

Approves all entries to the provider professional billing record in EPIC.

Collaborates on provider related claim denials and acts as liaison between payor until resolve and claim reprocessed and paid.

Assists with payor transparency by communicating to payor any discrepancies between payor and enrollment information.

Responsible for reaching out to physicians and allied health professionals directly to obtain access via the CMS PECOS portal to obtain access to act on their behalf for Medicare enrollment and NPI updates via the NPPES portal.

Responsible for updating and entry of all physician and allied health professional credentialing information into the Symplr provider database shared with the CSO to include practice address information.

Assist with projects related to new practice locations to include relocation and changes for such. Including working with project manager on EPIC information, updating of Symplr, notification of new location, change, etc. to Medicare/Medicaid/Department of Defense and managed care companies.

Maintains confidentiality of credentialing and enrollment information

Provides backup coverage to the others on the enrollment team.

In addition to above job responsibilities, other duties may be assigned.

MINIMUM REQUIREMENTS

Education: High school graduate or equivalent required. Bachelors Degree Preferred.

Experience: 5 years' prior experience in a healthcare environment. Experience working accurately under time pressures Experience anticipating end users' problems.

Licensure: None.

Skills: Intermediate knowledge of and experience utilizing a personal computer Intermediate word processing and spreadsheet skills. Basic knowledge of database software or willingness to attain such within 6 months of hire.

PHYSICAL DEMANDS

This is primarily a sedentary job involving extensive use of desktop computers. The job does occasionally require traveling some distance to attend meetings, and programs.

The starting base rate for this role is $52,436.80 annually. Individual compensation will be determined by the selected candidate's qualifications, previous work experience, and/or education.

Benefits

Comprehensive Benefits Package: Medical, Dental, and Vision Insurance

Paid Time Off, Long-term and Short-term Disability, Retirement Savings

Health Saving Plans, and Flexible Spending Accounts

Certification and education support

Generous Paid Time Off

UVA Health (https://jobs.virginia.edu/why-uva-health) is a world-class Magnet Recognized academic medical center and health system with a level 1 trauma center. 2023-2024 U.S. News & World Report "Best Hospitals" guide (https://health.usnews.com/best-hospitals/area/va/university-of-virginia-medical-center-6344000) rates UVA Health University Medical Center as "High Performing" in 5 adult specialties and 14 conditions/procedures. We are one of 70 National Cancer Institute designated cancer centers. UVA Health Children's (https://jobs.virginia.edu/uva-childrens) is named by 2023-2024 U.S. News & World Report (https://health.usnews.com/best-hospitals/area/va/university-of-virginia-childrens-hospital-PA6344000) as the best children's hospital in Virginia with 9 specialties ranked among the best in the nation. Our footprint also encompasses 3 community hospitals and an integrated network of primary and specialty care clinics throughout Charlottesville, Culpeper, Northern Virginia, and beyond.

The University of Virginia is an equal opportunity employer. All interested persons are encouraged to apply, including veterans and individuals with disabilities. Learn more about UVA's commitment to non-discrimination and equal opportunity employment (https://eocr.virginia.edu/notice-non-discrimination-and-equal-opportunity) .

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