MEDICAL STAFF ENROLLMENT SPECIALIST, FULL TIME DAYS

Description

Carson City, NV | Full Time US:NV:Carson City MEDICAL STAFF

About Carson Tahoe Health

CTH is a not-for-profit healthcare system with 240 licensed acute care beds, fully accredited by the Center for Improvement in Healthcare Quality (CIHQ). CTH was voted 5 th most beautiful hospital in the nation nestled among the foothills of the Sierra Nevada in North Carson City and only a short drive away from world-famous Lake Tahoe & Reno. We serve a population of over 250,000 and feature two hospitals, two urgent cares, an emergent care center, outpatient services and a provider network with 19 regional locations.

Summary

The Provider Enrollment Specialist administers the physician, PA, and APRN enrollment and credentialing applications process. The Provider Enrollment Specialist is responsible for preparing and submitting credentialing applications and supporting documentation for the purpose of enrolling individual physicians and physician groups with State, Federal, and commercial payers and hospitals when necessary. In this role, you will ensure the set up of electronic claims submission and electronic remittance advice. You will follow up on the status of enrollments and track the progress on all pending applications. Additionally, this position will support the function of the Medical Staff Office.

Responsibilities

• Implements the physician enrollment and credentialing process for providers across the Carson Tahoe Health System. Maintain the timelines on enrollment/credentialing schedules, communicate with providers and other departments to update as needed, clarify carrier information requirements, and maintain a strict level of confidentiality for all matters pertaining to provider credentials.
• Reviews new provider packet information to determine any enrollment issues.
• Coordinates credentialing data needed for enrollment, contracting, and other related purposes. Credentialing data includes but is not limited to the medical degree, Drug Enforcement Administration (DEA) number, state license number, Board certifications, CV, malpractice insurance and state insurance form.
• Works closely with Physicians to obtain missing documentation for providers pertaining to provider enrollment. Obtains appropriate authorized signatures and follows up with the carriers on documentation submitted. • Maintains provider information and demographics for all providers and assists in central credentialing database management.
• Responds to internal and external inquiries on routine enrollment and contract matters.
• Monitors and updates all expirables including but not limited to State Medical Licenses, Nevada Board of Pharmacy, DEA, and Professional Liability Insurance.
• Responsible for facilitating and coordinating the proctoring process for newly credentialed medical staff members.
• Performs other related duties as assigned.

Qualifications

Required

• High School Diploma or equivalent.
• Three to five (3-5) years experience in Managed Care or another healthcare setting with responsibilities relating to credentialing and provider enrollment.
• Medicare, Medicaid, and Commercial Payer Provider enrollment knowledge.
• Knowledge of medical insurance carrier policies and procedures, State and Federal rules and regulations.

Preferred

• Certified Provider Credentialing Specialist (CPCS) OR Certified Professional Medical Services Management (CPMSM).
• Understanding of Medical Staff Governance and Peer review processes

Top 5 Reasons to Live in Carson City, Nevada

• Live, work and play in one of the most beautiful regions in the world
• Enjoy an array of outdoor activities world class skiing, golf, camping, mountain biking, hiking, water skiing, kayaking, hunting and fishing
• Just next door is Beautiful Lake Tahoe
• We are minutes from Reno known as the 'biggest little city in the world' - Fine dining, nightlife, shopping and home to the University of Nevada Reno.
• Family friendly atmosphere with affordable housing & excellent school system

Our Benefits

• No State Income Tax
• Medical, Dental, Vision, FSA, Telehealth
• Paid Time Off, Mental Health, and Volunteer Days
• 100% Vested 401K & Roth with Company Contribution
• Tuition Reimbursement
• Referral Bonuses
• On Site Education & Certification Programs
• Base Wage Increases for Relevant Advanced Degrees
• Free Calm App Subscription