Provider Enrollment Specialist - CAP

Cayuga Medical Center at Ithaca, Inc. is hiring a Provider Enrollment Specialist to manage provider and organization data and complete enrollment and revalidation applications for Cayuga Health Partners Network and Centralus Health. The role coordinates with providers, practices, and health plans to maintain accurate provider rosters and ensure compliance with payer and regulatory requirements.

Responsibilities

• Perform provider enrollment activities as necessary
• Manage the completion and submission of provider enrollment applications for CHP providers according to plan specifications. Understand specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.) and regulations
• Review and assess for completeness of information of enrollment documents, including current state licensure, liability insurance, DEA, etc
• Responsible for follow-up with physicians and providers on missing information needed to complete payer enrollment
• Responsible for the generating, mailing, tracking, and subsequent processing of provider revalidation applications. Interacts with representatives from health plans in an effort to resolve any delays in approvals as well as CHP Participants to answer inquiries and clarify requirements
• Update Provider Data Management System when new information is received
• Responsible for working with health plans on a routine basis to maintain their Provider Rosters
• Responsible for notification to health plan and applicable CHP participants. Notification includes date of contract termination, anticipated health plan termination (if different than contract termination) and provider for membership re-assignment.*
• Maintain a current and accurate Provider Roster, communicating provider changes to appropriate CHP staff to support Network Initiatives
• Maintains extensive working knowledge of provider enrollment.*
• Is flexible in assuming other appropriate responsibilities not noted above

Preferred

• Notary Public certification
• Notary Public Certification

Benefits

• Comprehensive benefits
• Professional development opportunities
• Hybrid position available; preferred one to two days per week in the office as needed in Ithaca, NY.

Company

• Regional healthcare provider with hospitals and medical practices
• https://centralushealth.org/
• 5001-10000 employees

Qualifications

• Associate's degree
• Two to five (2-5) years of experience, including previous provider enrollment or credentialing experience with IPA / Medical Group / Hospital experience or healthcare operations experience (i.e. claims processing, billing, provider relations or contracting)
• Notary Public certification

Required skills

• Claims Processing, Healthcare Contracting, Healthcare Operations, Medical Billing, Notary Public Certification, Provider Credentialing, Provider Enrollment, Provider Relations

Preferred skills

• Notary Public certification

Experience

• 2-5 years