OK-SSM Health St. Anthony Hospital - Oklahoma City
Worker Type:
Regular
Job Summary:
Responsible for proactive enrollment of physicians and other health care practitioners for participation in government programs and with contracting commercial payers.
Job Responsibilities and Requirements:
PRIMARY RESPONSIBILITIES
Responsible for identifying denial trends and working with team to facilitate root cause analysis and continuous process improvement.
Prepares and submits government credentialing applications and supporting documentation for the purpose of enrolling and re-enrolling individual physicians and other healthcare practitioners with Medicare, Medicaid and other government payers.
Prepare and submit government payer re-credentialing applications as required by Medicare, Medicaid or other government payers.
Coordinate with regional managed care staff to ensure physicians and other health care providers are enrolled timely with contracted commercial payers.
Work claim edit work queues and add provider identification numbers to Epic to ensure claims are released for payment.
Follow up on claims that are rejected or denied due to provider enrollment issues.
Coordinate with medical group leaders and clinic staff on all enrollment matters, including receiving timely notification of new providers, obtaining necessary enrollment documents timely and providing feedback relating to provider issues that impede the enrollment process.
Performs other duties as assigned.
EDUCATION
High school diploma or equivalent
EXPERIENCE
Three years' experience
PHYSICAL REQUIREMENTS
Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
Frequent keyboard use/data entry.
Occasional bending, stooping, kneeling, squatting, twisting and gripping.
Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
Rare climbing.
Work Shift:
Day Shift (United States of America)
Job Type:
Employee
Department:
78050033 System/Regional Srvs
Scheduled Weekly Hours:
40
SSM Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.
