Payor Enrollment Specialist
- Requisition ID
- 01 - Days
- Cred/Med Staff Srvcs
- Support Services
- Position Type
- Regular Full-Time
- Physical Work Location and New Employee Orientation Location : Address
- 2500 W UTOPIA
- Work Hours
- M-F 8am-4:30pm
HonorHealth is a non-profit, local healthcare organization known for community service and outstanding medical quality. HonorHealth encompasses five acute care hospitals with approximately 11,500 employees and 4,500 volunteers, over 70 primary and specialty care practices, clinical research, medical education, an inpatient rehabilitation hospital, an Accountable Care Organization, two foundations, and extensive community services.
HonorHealth is a leader in medical innovation, talent and technology with a genuine commitment to your growth. The health system's vibrant careers take place in an environment filled with opportunity and respect because we see the HONOR in you.
High School Diploma or GED Required
Two (2) years’ credentialing, payor enrollment, medical staff or administrative assistant including data entry, in a hospital or healthcare environment. Required
The Payor Enrollment Specialist is responsible for providing enrollment and payor credentialing information to insurance and health plans to support the processing of payor applications and reapplications. Provides enrollment support to the centralized appointment and reappointment process including reports and obtaining required data from the health plans and appropriate internal departments, in accordance with all appropriate regulatory agencies standards
- Provides payor enrollment and credentialing support to the credentialing manager. Maintains a sound working knowledge of payor enrollment, payor credentialing and provides consultation regarding payor enrollment and credentialing, to ensure all processes are in compliance with state statutes and regulatory agencies as demonstrated by observation.
- Responsible for timely processing of health plan initial applications and reappointment applications for completeness and in accordance with appropriate standards. Communicates with health plans during enrollment process to ensure timely and expeditious completion of process. Researches incidents, submission of applications for timely processing and uploading to payors, maintains accurate effective dates and request appropriate follow-up information from payors or other sources as indicated. May be responsible for gathering information and perform research in contract disputes between health plans and providers.
- Maintains the payor enrollment and credentialing database for physician and faculty. Ensures data is accurately entered as evidenced by audit. Prepares reports in compliance with requests for information as demonstrated by documentation.
- Maintains adherence to professional confidentiality standards established within the Department and in accordance with legal, ethical and hospital, payor enrollment and credentialing, and medical staff policies. Assures data security and confidentiality by use of appropriate labeling of information and storage, and appropriately securing cabinets and drawers.
- Performs other duties as assigned.
It is the policy of HonorHealth to provide equal opportunity in employment. Selection and employment of applicants will be made on the basis of their qualifications without regard to race, color, religion, creed, national origin, age, disability, sexual orientation, marital status, veteran status or any other legally protected status.
Please review the Equal Employment Opportunity poster.
Please review the Equal Employment Opportunity Poster.HonorHealth wants all interested and qualified candidates to apply for employment opportunities. If you are an applicant with a disability who is unable to use our online tools to search and apply for jobs, please contact us at EmploymentOffice@HonorHealth.com . Please indicate the specifics of the assistance needed. This option is reserved only for individuals with disabilities that are unable to use the online tools and is not intended for other purposes.