FGP Senior Provider Enrollment Specialist - Boynton Beach, Florida at NYU Langone Health

Boynton Beach, Florida, United States -

Full Time

Start Date

Immediate

Expiry Date

16 Jun, 26

Salary

0.0

Posted On

18 Mar, 26

Experience

10 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Provider Enrollment, Credentialing, Re-credentialing, Database Maintenance, Training, Issue Resolution, Reporting, Compliance, System Testing, Data Integrity Audits, Cactus Database, NCQA, JCAHO, CAQH, Communication, Project Management

Industry

Description

Position Summary: We have an exciting opportunity to join our team as a Faculty Group Practice Senior Provider Enrollment Specialist. Under the direction of the Managers and Director of Credentialing Operations, Clinical Affairs and Affiliates, the Credentialing Specialist of Credentialing Operations is responsible for provider enrollment and related reporting activities. The Specialist will ensure providers are credentialed and enrolled into contracted health plans timely with accurate information for members and billing. The Specialist will lead processes include but not limited to intake, credentialing and re-credentialing, direct enrollment, delegation related activities, trouble shooting and resolving provider enrollment issues, as well as maintenance and monitoring of accurate credentialing database for all providers. The Specialist is responsible to train the Credentialing team to improve accuracy of the credentialing database and other NYU provider systems; ensure timely and successful of provider enrollment as well as timely responses and resolutions of FGP CRED inquiries/issues. The Specialist will provide feedback to management in processes and staff performance to improve the teams overall productivity and performance. The Specialist is responsible for preparing recommendations and reports to management, FGP administration and practice managers regarding provider enrollment processes and performances. Job Responsibilities: * Act as a liaison between NYU FGP Credentialing and Governmental/Commercial/Managed Care plan representatives to ensure compliance with all contractual guidelines and responsibilities as a contracted provider as well as a delegated entity, including timely and accurate provider data maintenance for plans surveys and payment. * Other duties and projects as assigned by the Managers and Director of Credentialing Operations * Provide support and insight for other workflows and special projects. * Must consistently maintain the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to the applicable federal, state and local laws and regulations, accreditation and licenser requirements * Responsible for system testing during all system upgrades or migrations * Coordinate with Central Billing Office, Professional Billing Information Systems and FGP administration to ensure credentialing system/billing system interface performance and appropriate claims production * Notify appropriate constituents when providers are departing the FGP and reconcile this information to ensure appropriate systems and reconciliations are reported. * Maintain strong communication with practice administrators and/or business managers to assess and resolve any outstanding business needs * Ensure timely responses to internal customer population via the FGP Insurance/Credentialing inbox * Monitor performance of FGP Insurance/credentialing inbox, its staff and workflow. * Train internal staff as well as overseas data center (Vendor) in processes, providing initial and on-going guidance. Resolves and addresses procedure and performance related issues. * Initiate and conduct routine and ad-hoc audits on provider data integrity to ensure business rules are enforced for data submissions to the governmental and other healthcare payers * Oversee the governmental/delegated payers credentialing issue tracking mechanisms * Establish and maintain working relationships with representatives from governmental payers and major healthcare payers Minimum Qualifications: To qualify you must have a Bachelors degree required with ten (10) years experience working in credentialing, managed care, or healthcare management or equivalent combination of experience and education. Over five (5) years experience of managed care and governmental contracting and claims operations Proven experience in project management of large scaled system integration/migration projects Knowledge of Cactus Database is a must Knowledge of NCQA, JCAHO, CAQH and other applicable federal regulations as related to credentialing. Excellent organizational skills; ability to prioritize and keep tasks moving forwardSelf-starter; high initiative; able to work both autonomously/independently and as a team member. Exceptional skills in partnering with IT, clients, vendors, and staff and in developing and maintaining long-term supportive relationships Light, accurate keyboarding skills required. Candidates must receive a score of 35 words per minute (wpm) or greater on the typing assessment that will be administered prior to onboarding. Qualified candidates must be able to effectively communicate with all levels of the organization. NYU Langone Florida provides its staff with far more than just a place to work. Rather, we are an institution you can be proud of, an institution where you'll feel good about devoting your time and your talents. At NYU Langone Health, we are committed to supporting our workforce and their loved ones with a comprehensive benefits and wellness package. Our offerings provide a robust support system for any stage of life, whether it's developing your career, starting a family, or saving for retirement. The support employees receive goes beyond a standard benefit offering, where employees have access to financial security benefits, a generous time-off program and employee resources groups for peer support. Additionally, all employees have access to our holistic employee wellness program, which focuses on seven key areas of well-being: physical, mental, nutritional, sleep, social, financial, and preventive care. The benefits and wellness package is designed to allow you to focus on what truly matters. Join us and experience the extensive resources and services designed to enhance your overall quality of life for you and your family. NYU Langone Florida is an equal opportunity employer and committed to inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration. We require applications to be completed online. View Know Your Rights: Workplace discrimination is illegal [https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf]."

Responsibilities

The Senior Provider Enrollment Specialist is responsible for managing provider enrollment and related reporting activities, ensuring timely and accurate credentialing into contracted health plans. This role involves leading processes such as intake, credentialing, re-credentialing, direct enrollment, troubleshooting issues, and maintaining the accuracy of the credentialing database.