Overview
Responsible for the coordination of D-HH provider enrollment, Epic SER access, and insurance related claims management.

Responsibilities

• Serves as liaison between D-HH credentialing, D-H contracting, Conifer RMD, external payors and facilities.
• Enrolls providers for network participation with Governmental and contracted Commercial/ Managed Medicaid health plans.
• Assists in the development and maintenance of the credentialing database. Enters new data and updates existing enrollment records.
• Reviews claim work queues, conducts necessary research, and works with the appropriate parties to correct edits or address denials.
• Manages the resolution of enrollment issues relating to timely and accurate reimbursement of services.
• Generates NCQA/ delegated credentialing provider exclusion queries.
• Submits provider demographics for initial Epic EMR access and terminates inactive provider records.
• Maintain aspects of the Epic provider SER records, including but not limited to; demographics, billing, admitting, departments/revenue routing.
• Maintains electronic prescribing rights (EPCS) and state license data.
• Maintains, tracks, and enters enrollment confirmations into the credentialing database and Epic, controlling claims submission.
• Coordinates, schedules and participates in managed care audits. Reviews files prior to audit.
• Assists with updates and changes that effect how services are billed.
• Reports on missing provider information.
• Audits data to ensure accuracy for reporting to payers.
• Responds to DHSM tickets regarding provider access issues.
• Performs other duties as required or assigned.

Qualifications

• High School diploma or the equivalent required.
• Minimum of two years healthcare experience required.
• Strong written and verbal interpersonal skills required.
• Must be detail oriented.
• Experience with CAQH is preferred.
• Experience with Epic is preferred.
• Demonstrated proficiency in word processing, spreadsheet software, database management and data entry preferred.

• Serves as liaison between D-HH credentialing, D-H contracting, Conifer RMD, external payors and facilities.
• Enrolls providers for network participation with Governmental and contracted Commercial/ Managed Medicaid health plans.
• Assists in the development and maintenance of the credentialing database. Enters new data and updates existing enrollment records.
• Reviews claim work queues, conducts necessary research, and works with the appropriate parties to correct edits or address denials.
• Manages the resolution of enrollment issues relating to timely and accurate reimbursement of services.
• Generates NCQA/ delegated credentialing provider exclusion queries.
• Submits provider demographics for initial Epic EMR access and terminates inactive provider records.
• Maintain aspects of the Epic provider SER records, including but not limited to; demographics, billing, admitting, departments/revenue routing.
• Maintains electronic prescribing rights (EPCS) and state license data.
• Maintains, tracks, and enters enrollment confirmations into the credentialing database and Epic, controlling claims submission.
• Coordinates, schedules and participates in managed care audits. Reviews files prior to audit.
• Assists with updates and changes that effect how services are billed.
• Reports on missing provider information.
• Audits data to ensure accuracy for reporting to payers.
• Responds to DHSM tickets regarding provider access issues.
• Performs other duties as required or assigned