Provider Enrollment Coordinator
Job ID: R0038518 | General Compliance | Full Time | Charlottesville, VA
This position will assist UVA Community Health (UVACH) in complying with all UVACH-delegated credentialing and enrollment functions for managed care organizations in addition to government payors, such as Medicare, Virginia Medicaid, and Railroad Medicare. Responsible for employed and contracted providers for UVACH by maintaining provider eligibility to bill third-party payors for the provision of healthcare services. Such functions include enrollment of all new physicians with government and managed care payors with whom there is no delegated credentialing agreement by completing two enrollment applications per payor. In addition, this position will include working directly with UVACH to determine provider employment status and tracking of active hospital privileges at the three UVACH hospitals to maintain current access for professional billing.
  • Initiates and maintains contact with professional providers in an effort to request and be granted access to handle enrollment application for Medicare through the CMS PECOS system to ensure the highest level of accuracy.
  • Prepares and submits Virginia Medicaid application through the Virginia Medicaid centralized web portal to ensure the highest level of accuracy.
  • Completes RR Medicare application based on information provided from Medicare.
  • Completes CAQH applications for managed care organizations with whom CAQH participates.
  • Completes enrollment application for managed care organizations with whom UVACH does not have delegated credentialing.
  • Responsible for tracking of all applications until completed and approved by Medicare, Virginia Medicaid, RR Medicare, and all managed care organizations.
  • Works directly with billing vendor to enter billing information into system, such as bill areas, etc.
  • Works directly with billing vendor to release charges once approved by managed care organizations, Medicare, Virginia Medicaid, and RR Medicare to release charges being held and claims released from AR.
  • Participates with billing office and managed care organizations, Medicare, Virginia Medicaid, and RR Medicare in an effort to resolve all claim denial issues related to provider credentialing.
  • Works with payors on changes, such as address changes to both physical location and payment address, name changes, etc.
  • Responsible for creation of tables to forward to billing vendor of all new physicians and advanced practice providers being issued privileges by UVACH, as well as changes to existing physicians/advance practice providers once privileges are issued/changed or terminated.
  • Assists with payor transparency by communicating to payor any discrepancies between payor and UVACH enrollment information.
  • Responsible for updating and entry of all physician and advanced practice provicers credentialing information into the Symplr software system, primary practice address, specialty, Epic specialty codes, and taxonomy codes.
  • Provides backup coverage to peer, Provider Enrollment Coordinator and Provider Employment and Enrollment Coordinator as needed.

Education:
  • High school graduate or GED.

Experience:
  • 5 years of experience in a healthcare environment.
  • 3-5 years of experience in administration of managed care products preferred.
  • Experience working accurately under time pressures.
  • Experience anticipating end users' problems.

Knowledge and 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.

Competencies:
  • Customer Focus: Knowing the (internal and external) customer business needs and acting accordingly, anticipating customer needs, and giving high priority to customer satisfaction and customer service.
  • Attention to Detail: Taking responsibility for a thorough and detailed method of working.
  • Planning and Organizing: Setting priorities and defining actions, time, and resources needed to achieve predefined goals.
  • Problem-Solving: Having the ability to identify problems and issues of varying complexities and to find effective solutions with few guidelines.
  • Initiative: Spotting opportunities within a circle of influence, anticipating threats, and acting on them. Self-starting rather than waiting passively until the situation demands action.
  • Stress Tolerance: Performing well when faced with pressure due to time frame, workload, adversity, disappointment, or opposition.



COVID Vaccination Requirement and Guidelines

 

Please visit the UVA COVID-19 Job Requirements and Guidelines webpage prior to applying for current information regarding vaccination requirements and guidelines for employment at UVA.

 

 

 

Tina Rosson
Tina Rosson
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Charlottesville, VA
Charlottesville, VA 22903
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Tina Rosson
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Since 1979, UPG has been the clinical partnership group managing, growing and providing direct patient care for all UVA entities. This strategic partnership allows UVA to expand on education, technology, diagnostics, resources and facilities while the teams at UPG can focus on managing and delivering high-quality, multi-specialty care.

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