Enrollment Specialist - Remote

**Description** **AdventHealth Corporate** **All the benefits and perks you need for you and your family:** · Benefits from Day One · Career Development · Whole Person Wellbeing Resources · Mental Health Resources and Support **Our promise to you:** Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that **together** we are even better. **Shift** : Monday-Friday **Job Location** : Remote **The role you’ll contribute:** Responsible for physician systems including applications and credentialing for various physician groups and specialties for which contracting services are provided. Maintains and updates all credentialing systems with current information for all physicians/providers. Responsible for coordinating and maintaining all credentialing documents necessary to complete credentialing and re-credentialing of all physicians/providers for which we contract. Responsible for auditing and data analysis for all physician/provider credentialing records, documents and files. Responsible for programming Apogee applications to generate reports necessary to ensure accuracy of physician/provider records. Actively participates in physician group leadership meetings and is accountable for presenting credentialing status for all groups. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. **The value you’ll bring to the team:** **PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:** **Physician Groups and Systems-18%** · Responsible for the credentialing efforts for primary care and/or specialist physician and/or mid-level providers employed by AHS Florida Division physician groups. · Responsible for understanding and utilizing the functionality of Apogee (or any subsequent credentialing database) and training new employees. · Responsible for programming physician/provider applications within Apogee (or any subsequent credentialing database) and works.to ensure physician/provider information is complete, accurate, and up to date. · Ensures that credentialing applications are scanned and programmed to populate with physician information. · Assists in maintaining a complete database (including CAQH) of all credentialing materials for all employed physicians/providers. · Utilizes advanced level of skill relating to the understanding of payer credentialing nuances and disseminates such information and trains team members as necessary. **Communication-15%** · Communicates with physician/provider office staff and practice management regarding the status of applications, additional materials required, etc. · Educates physician/provider and physician/provider leadership staff on necessary documentation needed in order to credential physician/provider. · Responsible for ensuring that all documents are up to date and new documents are requested from practice management for any that may be expiring. · Effectively communicates and is accountable to staff, leadership, payors, providers, patients, and visitors. · Effectively participates and plays an integral role in meetings and discussions with regional leadership to include Managed Care Directors, Physician Group Leadership and staff in regard to internal issues, physician onboarding issues and payer issues. · Deals with patient information in a sensitive manner to ensure respect and privacy for patient and expeditious handling of related issues. **Support-12%** · Supports the Credentialing Manager and Director of Credentialing and Revenue Management by resolving problems, questions, and issues internally, as well as at the payer and the practice. · Supports physician contracting and operation services by auditing and analyzing data, verifying applications, preparing amendment letters, ensuring physician/provider credentialing materials are processed efficiently, professionally and as expeditious as possible. Researches any inconsistencies or discrepancies as assigned by leadership and educates entire team of findings. · Supports the Negotiators through notification of current application status and new contract requirements. Assists and guides physicians/providers in determining information necessary for applications. · Supports the overall mission of Adventist Health System and the role of the Managed Care department in that mission. Demonstrates an eagerness to assist co-workers in the completion of tasks as needed. · Performs special projects and tasks as requested by senior staff and leadership. · Supports the contracting team, internal departments, ancillaries, and physician groups, and owned PHOs as applicable, to assist with, identify, and resolve operational, accounts receivable, utilization management, quality assurance, billing and other related issues. **Liaison & Information-10%** · Acts as provider relations’ representative to physician groups in order to assist with operation and payment issues, as appropriate. · Prints applications upon request and compiles specific information for re-credentialing · Responsible for ensuring credentialing information is accurate and current in multiple venues such as hospital systems, local databases such as Apogee and Microsoft Access, files, and on-line databases such as CAQH. · Coordinates process with Negotiators to ensure contracts are in place prior to sending applications to payer. · Represents the Credentialing Manager and/or Director of Credentialing and Revenue Management in meetings when assigned to do so. **Development, Education and Training-10%** · Displays a willingness to grow and develop skills required to perform his/her job duties and assist with the training and education of team members. · Takes the initiative to seek out education and training experience in order to grow and develop skills necessary to perform Enrollment Specialist duties and to stay informed of changes in the field of managed care and objectives of the department. · Ability to assess individual credentialing staff member performance and communicates with leadership on needed areas of improvement. · Assists leadership in ensuring all applicable internal policies, procedures and guidelines are adhered to by all team members. **Deadlines, Timeliness and Performance Standards-15%** · Completes assigned tasks in the appropriate time period and maintains an acceptable work pace. · In group situations, effectively contributes to the overall completion of work product according to the applicable directive and deadline. · Does not interfere with the ability of co-workers to complete their duties. · Readily able to adapt to new situations and changing priorities in order to accomplish department goals. · Adheres to applicable internal policies, procedures, and guidelines set forth by Adventist Health Systems, its associated hospitals, physician groups, PHOs, and ancillaries during the execution of assigned duties. · Abides by all applicable rules, regulations, and laws prescribed by any authoritative governing body such as the State of Florida, AHCA, etc. **Qualifications** **The expertise and experiences you’ll need to succeed:** **KNOWLEDGE AND SKILLS REQUIRED:** · Typing: 35wpm · Word processing · Spreadsheet experience · E-mail and computer calendar experience · Detail-oriented · Windows Applications: · Microsoft Word, Excel, PowerPoint, Access, Outlook **_KNOWLEDGE AND SKILLS PREFERRED:_** · PCAnywhere · Apogee · CAQH · MSOW/Apogee **EDUCATION AND EXPERIENCE REQUIRED:** · High school diploma or equivalent · Minimum of four years’ experience in healthcare; preferably in managed care, provider credentialing, patient financial services or provider relations **_EDUCATION AND EXPERIENCE PREFERRED:_** · Bachelor’s degree in business, healthcare administration or related field · Four or more years in healthcare or managed care This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. **Category:** Managed Care **Organization:** AdventHealth Corporate **Schedule:** Full-time **Shift:** 1 - Day **Req ID:** 23034885 We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.