Job Description

It's more than a career, it's a calling.

MO-REMOTE

Worker Type:

Regular

Job Highlights:

Play a key role behind the scenes in ensuring providers are properly credentialed and enrolled with health plans, enabling seamless access to care for patients. In this collaborative, detail-driven role, you will manage enrollment processes, maintain accurate provider data, and partner across teams to resolve issues and support operational success. If you thrive in a fast-paced environment and enjoy working across systems and teams, this is a great opportunity to make a meaningful impact.

Responsible for proactive enrollment of physicians and other health care practitioners for participation in government programs and with contracting commercial payers.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• Responsible for identifying denial trends and working with team to facilitate root cause analysis and continuous process improvement.
• Prepares and submits government credentialing applications and supporting documentation for the purpose of enrolling and re-enrolling individual physicians and other healthcare practitioners with Medicare, Medicaid and other government payers.
• Prepare and submit government payer re-credentialing applications as required by Medicare, Medicaid or other government payers.
• Coordinate with regional managed care staff to ensure physicians and other health care providers are enrolled timely with contracted commercial payers.
• Work claim edit work queues and add provider identification numbers to Epic to ensure claims are released for payment.
• Follow up on claims that are rejected or denied due to provider enrollment issues.
• Coordinate with medical group leaders and clinic staff on all enrollment matters, including receiving timely notification of new providers, obtaining necessary enrollment documents timely and providing feedback relating to provider issues that impede the enrollment process.
• Performs other duties as assigned.

EDUCATION

• High School diploma/GED or 10 years of work experience

EXPERIENCE

• One year experience

PHYSICAL REQUIREMENTS

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare climbing.

REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS

• None

Department:

Work Shift:

Day Shift (United States of America)

Scheduled Weekly Hours:

40

Benefits:

SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.

• Paid Parental Leave we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).

• Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.

• Upfront Tuition Coverage we provide upfront tuition coverage through FlexPath Funded for eligible team members.

Explore All Benefits

SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity,pregnancy, veteran status , or any other characteristic protected by applicable law. Click here to learn more.