Nivano Physicians Hiring for Data Entry and Provider Enrollment Specialist Job at California Full Time

JOB DESCRIPTION

TITLE: Data Entry and Provider Enrollment Specialist

DEPARTMENT: Credentialing

DEPARTMENT MANAGER: Director of Credentialing and Contracting

POSITION SUMMARY

Responsible for the processing and maintenance of all enrollments related changes and updates. Interfaces with a variety of internal and external provider offices including but not limited to Primary Care, Specialty, and Ancillary providers. Responsible for all provider data entries into QuickCap and MD Staff when necessary.

Essential Functions and Responsibilities include the following:

· Manage and track all new provider enrollment applications by electronic and/or by paper and ensure all applications are stored and filed properly

· Load all new contracted provider applications

· Monitor department email for incoming credentialing requests, data entry updates and changes for all provider types and terminations. Respond and communicate to providers timely

· Download the received applications and/or download applicable CAQH applications, supporting credentials, and email or letter requests for the addition, add documents to proper credentialing folder and store documents for processing

· Update the provider and organization profiles as necessary with the appropriate documentation and document storage

· Prepare provider rosters as requested

· Perform database updates and reconciliation of large group demographic validations on a quarterly basis or more often when necessary (FQHC’s or large specialty groups, AHPN, etc.)

· Communicate with internal and external customers, including but not limited to, Medi-Cal and Health Plans to gather appropriate information and report any pended information to internal leadership

· Add intermittent UM provider requests for non-contracted providers, changes, updates, and new contracted providers per contract and credentialing protocols

· Perform non-contracted or non-enrolled contracted provider entries for claim processing (intermittent coverage for check runs only)

· Process monthly submissions of newly credentialed providers added to the networks and enroll with the applicable health plans

· Manage and maintain provider rosters

· Compile and maintain standardized company documents/attachments as appropriate, included but not limited to profiles and term notices

· All other duties as assigned

ADDITIONAL JOB REQUIREMENTS

· Regular scheduled attendance – subject to applicable laws and Nivano Physicians, Inc. policies, regular attendance is an essential function of the position. All employees must follow Nivano Physicians’ employment practices and policies.

QUALIFICATIONS

· Strong verbal and written communication and interpersonal skills

· Strong proficiency with Microsoft Word and Excel

· Effective knowledge of IPAs preferred

· Knowledge of healthcare, Managed Care, Medi-Cal, and Medicare preferred

· Ability to follow the chain of command, self-motivated, and results orientated

· Ability to work independently without direct supervision

· Ability to balance multiple priorities and to work under tight deadlines while providing consistent and professional service

· Ability to work in Sacramento, CA

· Ability to work in the US

Job Type: Full-time

Pay: $23.00 – $26.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift

Supplemental Pay:

• Bonus pay

Work Location: Remote