Payer Enrollment Specialist

Profile

Overview
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

Under the direction of the Manager, Payer Enrollment and Delegation, the Enrollment Specialist is responsible for the enrollment of Yale New Haven Health System practitioners with non commercial payers (Medicare, Medicaid, Tricare). This includes initiating the enrollment process from notification that a new practitioner has been added to the network and collaborating with Credentialing Specialists within Medical Staff Administration and the practitioner to complete the application process. This involves accurate and timely entry of provider data including contact information, status changes, and ensuring that verification of all required credentialing criteria has been completed in accordance with all policies and other applicable standards. The position also includes responsibility for ensuring that the re-verification process and any interim or re-credentialing activities required by government payers occurs to ensure continuous, uninterrupted participation status for all practitioners. This position maintains up to date and thorough knowledge of non-commercial payer enrollment obligations at the State and Federal level.

EEO/AA/Disability/Veteran Responsibilities
1. Completes the government payer enrollment process for all new practitioners within established timeframes.
1.1 Obtains information needed for government payer application process from information on file or already available within Medical Staff Administration from the Medical Staff appointment process.
2. Completes maintenance updates and re-verification/re-validation for all practitioners within established timeframes.
2.1 Maintains and updates data on practitioners including, but not limited to: name changes, office location and demographic changes, collaborating or supervising MD updates/changes, linking practitioners to new groups, TINs, etc.
3. Responsible for populating and updating MSOW Network Manager to accurately reflect commercial and non-commercial (government) payer participation and related data.
3.1 Following each Credentials Committee meeting or approval of applicants by the Credentials Committee Chair; enters plans into MSOW including start date / effective date of each within three (3) business days or fewer.
Qualifications
EDUCATION
Associate's Degree or equivalent experience preferred.
EXPERIENCE
Minimum of 2-3 years experience in non commercial payer enrollment.
LICENSURE
CPCS Certification preferred but not required.
SPECIAL SKILLS
Evidence of outstanding attention to detail and ability to follow through and meet hard deadlines; ability to prioritize and organize multiple tasks concurrently without losing track of deadlines with significant independence; ability to remain organized with interruptions; ability to adapt to changing priorities; initiative to problem solve issues to resolution and remain persistent in order to accomplish goals; outstanding verbal and written communication skills; proficient in EXCEL, Word and Outlook. Ability to learn new software programs quickly; Basic math skills; outstanding customer service skills;
PHYSICAL DEMAND
Must be able to sit at a computer for extended periods of time; some light lifting and walking around the organization as needed to interact with others.
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