Provider Enrollment Coordinator

**Employment Type:** Full time **Shift:** Day Shift **Description:** Responsible for completion of applications for provider enrollment for Medicare, Railroad Medicare, BCBS, Medicaid, Managed Care payers, and applicable Commercial payers in a timely manner and when received, notification to appropriate staff. Maintains a working knowledge of applicable federal, state, and local laws and regulations. Coordinates communication between payers and leadership and facilitate resolution of denials. Collaboratively work with several different departments and payer contacts to ensure a timely submission of enrollment applications.ESSENTIAL FUNCTIONS Knows, understands, incorporates, anddemonstrates theMercyOne Mission, Vision, and Values in behaviors, practices, and decisions. Maintains a working knowledge of applicable Federal, State, and local laws and regulations,NCQA standards,MercyOne Organizational Integrity Program, Standards of Conduct, as well as other policies and proceduresin order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Applies for provider NPI for new Residents to the organization andmaintains activity directory of providers NPI log in and password. Complete Managed Care checklist. Suppliesaccurate andtimely provider roster to Managed Care payers. Complete ACO quarterly roster reviews for updates and terminations. Facilitates the completion of Wellmark credentialing and recredentialing applications. Facilitates thecompletions of facility applications. Follows up onapplication process as needed for receipt of provider numbers in a timely manner. Notifiesappropriate staff when provider is approved for claims with the Health Plans. Keeps records of all providers, provider numbers and tax ID numbers. Verifies with insurance company provider eligibility. Documents all transactions of the provider application process. Maintains good working relationship with payer representatives. Collaborates with payer representatives toassist with claim denials. Demonstrates flexibility and adapts to changes in workload and assignments. Displays teamwork when co\-workers are absent. Assists in reducing others’backlog. Maintains a positive working relationship with co\-workers, medical staff, and personnel of other departments, andassists persons needinghelp as necessary. Assists inorientation of new employees. Responsible for system maintenance of Provider Codes and Group Codes. Responsible tomaintain current W\-9 forms. Establishes andmaintains Providerdatabase and other systems to assure accuracy of provider information. Prepares andparticipates in delegated credentialing oversight audits with commercial health plans. Operates andmaintains allneeded equipment, i.e., PC, fax, copier, printers, etc. Knows location and use of manualspertaining to claims processing. Accesses necessary information usingappropriate resources,i.e. m...