COLUMBIADOCTORS
PHYSICIAN ENROLLMENT GROUP
Position Description
Position:SENIOR ENROLLMENT COORDINATOR
Reports To:Enrollment Manager, with a dotted line to the Project Manager
Summary:
ColumbiaDoctors is one of the largest multi-specialty practices in the northeast and is affiliated with world renowned Columbia University Medical Center and NewYork-Presbyterian Hospital. ColumbiaDoctors is currently looking for a Senior Enrollment Coordinator for our Physician Enrollment Group located in Fort Lee, New Jersey.
Responsible for the timely, efficient and accurate enrollment of eligible providers in the ColumbiaDoctors network and respective delegated managed care plans. Develop and maintain relationships with Delegated Managed Care PlanRepresentativesand internal staff. Review and route all membership applications and affiliated documents according to PEG policies and procedures. Receives and reviews monthly payer rosters to ensure proper loading of ColumbiaDoctors demographic information based on data submitted. Responsible for executing significant quality assurance activities to maintain data integrity in PEG’s database and each Delegated Managed Care Plan databases.
Responsibilities:
- Provides coverage for senior level credentialing and enrollment operational functions, including but not limited to: (a)Review and submission of initial credentialing and recredentialing applications to the Credentials Verification Organization for primary source verifications. (b) Acts as a liaison between PEG and the Credentialing Committee Chair to review completed provider files prior to credentialing committee meetings. Notifies providers of discrepancies discovered through primary source verifications. (c) Prepares completed provider files for presentation and discussion at the credentialing committee by completing final review of credentialing requirements and determining appropriate level. (d) Timely notification of credentialing decisions to providers and departmental staff and designees. Updates credentialing database regarding credentialing decisions made by credentialing committee. (e) Management of the credentialing committee by coordinating monthly and ad-hoc meetings;preparation and distribution of committee meeting minutes. (f) Timely and accurate submission of monthly and ad hoc rosters to all Delegated Managed Care Organizations. Responsible for adhering to each plans requirements for roster submission. (g) Tracks the timely return of Delegated rosters from each Delegated MCO. Follows up with MCO’s when rosters are not returned per contractual requirements. Escalates delinquency to manager, as needed.
- Upon return of delegated rosters, verifies correct loading of physician demographic and tax identification information in payor system; audits all demographic and contractual data elements. Follows up with plan regarding incomplete rosters.
- Responsible for the distribution of provider id and effective dates to PEG staff for accurate and timely updating of PEG databases. Distribute pertinent information to departmental staff/designee in a timely fashion.
- Acts as liaison with Delegated Managed Care Organizations and holds meetings on a regular basis to discuss enrollment and credentialing issues.
- Facilitates straight Medicare and Medicaid enrollments on an as needed basis.
- Responsible for comprehensive Roster Reconciliations to ensure Managed Care Payors and PEG records accurately reflect participation status and valid demographics. Reviews provider participation rosters and compares information to PEG database. Follows up with payors for verification and completes reconciliations accordingly. Reviews and corrects provider demographic information.
- Generates monthly enrollment, credentialing, and demographic reports for publication on the PEG Secure Server, distribution to internal and external representatives; provides additional reports to departments as requested.
- Establishes and maintains positive relationships with physicians, administrators and Managed Care Payor representatives.
- Assists with new payer offering roll-outs, including but not limited to: providing opt-out documents to appropriate parties; tracking opt-out selections and submitting accurate initial load delegated roster files; comprehensive auditing of confirmation files prior to distribution of provider id and effective dates; participation in new payer offering meetings with contracting, departments and plans on an as needed basis.
- Responsible for providing coverage for responsibilities designated to PEG enrollment staff as they relate to credentialing, enrollment operations and provider data maintenance as needed. Cross-training will be provided to ensure that each Senior Enrollment Coordinator is able to perform a wide range of responsibilities designated to PEG enrollment staff.
- Responsible for executing quality assurance activities, including but not limited to: auditing IntelliCred data entry, generating and analyzing IntelliCred Data Compliance Reports and executingIntelliCred clean-up projects.
- Responsible for assisting withDelegated Plan Annual and Quarterly audits and reporting requirements.
- Assists with other special credentialing, enrollment and operational projects as needed.
Position Qualifications:
Minimum Education:Bachelor’s degree or equivalent in training, education and/or experience plus minimum two years related experience.
Related Course(s)/Training:Specialized knowledge ofCredentialing/Enrollment. One to three years experience in the use of relational databases and their supporting programs in Microsoft software. Advanced knowledge of Microsoft Word, Excel, Access or comparable word processing, spreadsheet and reporting software.
Skills:Customer service orientation a must. Time management and multi-tasking skills required. Communication skills, organizational skills, ability to prioritize and detailed oriented.
All applicants must apply online at:
We are an affirmative action/equal opportunity employer