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Delegation & Payor Enrollment Specialist, Seattle, WA


Organization: Proliance Surgeons, Inc.
Category: Professional
Location: Seattle, WA
Date Job Posted: July 15, 2020
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DELEGATION & PAYOR ENROLLMENT SPECIALIST

Proliance Surgeons

Proliance is one of the largest surgical practices in the country, providing excellent care at more than 100 centers throughout Washington State. Many of our surgeries are performed at our own ambulatory surgery centers—where costs are often lower and recovery times faster. Patients return home the day of their surgery to begin healing and rehabilitation and get back to doing what they love, faster. Each and every teammate has a crucial role as a part of our team focused on providing excellent patient care with high value for our patients, their families, employers, payors and our community.

What We Stand For:

At Proliance Surgeons, it is our mission to be the leader in physician-managed healthcare services. Each teammate contributes to our vision of excellent surgical and clinical care for every patient, every day. Our values of Integrity, Leadership, Loyalty, Mutual Respect and Innovation transcend all of our relationships: our patients and their loved ones, one another as team members, our business teammates and our community teammates. Every teammate is expected to embrace and demonstrate these shared values.

Position Summary

The Delegation & Payor Enrollment Specialist will handle all facets of the enrollment process for delegated plans.

Essential Qualities

  • Highly self-motivated, preferably with some experience in the healthcare physician credentialing, expirables management, re-credentialing, provider enrollment environment, medical insurance claims or medical industry in general
  • Success-driven and results-oriented, with the ability to implement and manage cross-functional projects
  • Proficiency with credentialing systems and learns new systems/processes quickly
  • Ability to interact effectively with a variety of people and be an excellent "ambassador" for the company
  • Provides highest level of customer service for both internal and external customers
  • Strong written and verbal communication skills, along with strong presentation and client interaction skills
  • Ability to prioritize tasks and projects
  • Accurate discernment on when to act independently and when to ask for guidance and/or assistance
  • Consistently demonstrates flexibility, a customer-focus, terrific organizational skills and a passion for details

Key Duties and Responsibilities

  • Prepare and submit spreadsheets to health insurance plans to ensure provider participation.
  • Update various databases to ensure proper tracking of enrollments and update requests.
  • Maintain necessary records of outstanding submissions and requests
  • Verify physician/provider information by searching third party databases
  • Update the company/third party databases with the physician/provider's ID number and start date
  • Maintain familiarity and stay current with health insurance plans' procedures
  • Coordinate all managed care credentialing activities to ensure provider participation status.
  • Maintain necessary logs, lists, records, and current documentation required for physician/provider credentialing and re-credentialing
  • Verify physician/provider information for managed care plans including communication with health plan representative and other staff as necessary
  • Follow-up with managed care companies to ensure expedient credentialing
  • Research and solve credentialing/re-credentialing problems. Perform a variety of routine clerical functions and projects as assigned
  • Maintain relationships with external managed care organization and clients as required
  • Provides highest level of customer service for both internal and external customers
  • Have a thorough understanding of company policy and processes, being able to adjust to fast paced, ever changing demands of the insurance industry in or to always be up to the minute with the latest information
  • Works with Account Managers & team leads in all phases of delegation and accurate entry & submission of credentialing information to payers
  • Ability to prioritize tasks and projects assigned to staff to meet deadlines and, the discretion to know when to act independently and when to ask for guidance and/or assistance
  • Remains current on policies affecting provider enrollment credentials & delegated clients/payers
  • Performs database and computer functions as required
  • Perform a variety of routine clerical functions and projects as assigned

Education & Experience

  • Education: High school diploma or GED required; Bachelor’s Degree is preferred
  • Experience: Two years of enrollment experience in the healthcare industry is required

Work Environment/Physical Demands

  • The work environment/physical demands described here are representative of those that must be met by a teammate to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Work is performed in an office environment. Requires corrected vision and hearing to normal range. While performing the duties of this job, the teammate is regularly required to talk or hear. The teammate is required to sit for long periods of time, stand and walk, bend and stretch. Use of telephone and computer is required. Manual dexterity required for use of computer keyboard. Occasionally lifts and carries items weighing up to 40 pounds. Requires working under stressful conditions or working irregular hours.

Comments

  • This description is intended to describe the essential job functions, the general supplemental functions and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities and requirements of a person so classified. Other functions may be assigned and management retains the right to add or change the duties at any time.

How to Apply:

If interested in applying, please email your cover letter and resume to reception@proliancesurgeons.com.


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