The Provider Enrollment Specialist ensures that initial and re-credentialing applications for St. Luke’s University Health Network (SLUHN) employed providers’ are submitted to identified third party and government health insurance carriers. Responsibilities also include maintaining membership and renewal information for professional and DEA licenses, board certification and professional organization memberships.
JOB DUTIES AND RESPONSIBILITIES:
Prepares provider enrollment applications and/or written link letters to be sent to payers
Ensures all providers and groups are re-validated with payers on a timely basis by completing re-credentialing applications with current provider information and signatures.
Makes and receives phone calls from providers and practice managers to help resolve payer issues and verify participating status.
Updates & maintains database to show enrollment tracking, effective dates, provider numbers and correct provider demographics.
Scans and files all paperwork and documents to a shared folder for tracking purposes and proof of submission to payers.
Applies for New Jersey licensure for identified providers.
Creates and submits new group enrollment applications for newly opened or moving practices. Fields and responds timely to inquiries from SLUHN departments to help resolve enrollment related issues.
Ensures SLUHN billing department has resolution on enrollment issues that assist with claim processing.
Identifies and communicates current or potential enrollment issues that could result in loss of revenue and/or patient dissatisfaction.
Participates in team meetings and conference calls with payers.
Completes online applications for Doing Business As (DBA) for new or renamed groups.
Creates check requests for out-of-state enrollment fees.
PHYSICAL AND SENSORY REQUIREMENTS:
Requires sitting for up to eight hours per day, including extensive use of computer terminal and telephone. Requires hearing as it relates to normal conversation and answering questions in large groups. Requires seeing as it relates to general near and far vision.
EDUCATION:
High School Education
TRAINING AND EXPERIENCE:
Experience with personal computers and the Microsoft Office suite of products is required. Strong customer service skills. Excellent verbal and written communication skills. Detail and service oriented.
Please complete your application using your full legal name and current home address. Be sure to include employment history for the past seven (7) years, including your present employer. Additionally, you are encouraged to upload a current resume, including all work history, education, and/or certifications and licenses, if applicable. It is highly recommended that you create a profile at the conclusion of submitting your first application. Thank you for your interest in St. Luke's!!
Founded in 1872, St. Luke’s University Health Network (SLUHN) is a fully integrated, regional, non-profit network of more than 23,000 employees providing services at 16 campuses and 350+ outpatient sites. With annual net revenue of $4 billion, the Network’s service area includes 11 counties in two states: Lehigh, Northampton, Berks, Bucks, Carbon, Montgomery, Monroe, Schuylkill and Luzerne counties in Pennsylvania and Warren and Hunterdon counties in New Jersey. St. Luke’s hospitals operate the largest network of trauma centers in Pennsylvania, with the Bethlehem Campus being home to St. Luke’s Children’s Hospital. Dedicated to advancing medical education, St. Luke’s is the preeminent teaching hospital in central-eastern Pennsylvania. In partnership with Temple University, the Network established the Lehigh Valley’s first and only four-year medical school campus. It also operates the nation’s longest continuously operating School of Nursing, established in 1884, and over 50 fully accredited graduate medical educational programs with more than 500 residents and fellows. In 2022, St. Luke’s, a member of the Children’s Hospital Association, opened the Lehigh Valley’s first and only free-standing facility dedicated entirely to kids. SLUHN is the only Lehigh Valley-based health care system to earn Medicare’s five-star ratings (the highest) for quality, efficiency and patient satisfaction. It is both a Leapfrog Group and Healthgrades Top Hospital and a Newsweek World’s Best Hospital. The Network’s flagship University Hospital has earned the 100 Top Major Teaching Hospital designation from Premier 13 times total and eleven years in a row, including in 2023 when it was identified as THE #4 TEACHING HOSPITAL IN THE COUNTRY.
