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Requisition Number 17-0134
Title Provider Enrollment Coordinator
Location UVA Research Park
City Charlottesville
State VA
Hours per week Full Time
Description University of Virginia Physicians Group
Job Description
POSITION TITLE: Provider Enrollment Coordinator
LEVEL/FLSA: 11, Non-exempt
DEPARTMENT: Human Resources and Development
REPORTS TO: Manager, Physician Employment & Delegated Credentialing


GENERAL SUMMARY: This position will assist UPG in complying with all UPG enrollment functions for employment and maintaining provider eligibility to bill third party payors for the provision of health care services. Such functions include enrollment of all new physicians with government and managed care payors, preparation of new files for review and approval by Manager of Delegated Credentialing & Physician Employment for entry into EPIC, and responsible for registration of providers in the PECOS system, including tracking of NPI login and password information, for the Medicare/Medicaid incentive programs.

PRINCIPAL DUTIES AND RESPONSIBILITIES:
Essential functions of the job:
 Handles enrollment information for Medicare and Medicaid to ensure the highest level of accuracy.
 Completes enrollment process including provider enrollment activities by completing applications for all
Medicare and Medicaid, including tracking of such applications until the provider numbers are issued.
 Works with Insurance Processing Unit departments in Billing and Collections by working Departmental
Requests on provider issue denials.
 Works with payors on changes, such as address changes to both physical location and payment address, name changes, etc.
 Responsible for collection of all bill area information from clinical departments to populate in Epic.
 Responsible for updating and maintaining specialty information in CACTUS to include Epic specialty codes.
 Responsible for creation of tables to forward to EPIC Dictionary Analyst of all new physicians and allied health professionals being issued privileges, as well as changes to existing physicians/allied health professionals entry providers once privileges are issued/changed or terminated. Authorizes any updates to the provider dictionary.
 Coordinates leased professional providers’ enrollment in all health care plans with the UPG contracts, to enable UPG to bill and collect on their behalf. Works with UPG legal to ensure leased employee accuracy by reviewing MOU.
 Reviews weekly Claim Edit Reports to identify claims held for reasons related to provider enrollment activities and intervenes as necessary to take appropriate action to release claims.
 Assists with payor transparency by communicating to payor any discrepancies between payor and the UPG enrollment information.
 Responsible for contacting physicians and allied health professionals directly to obtain their NPI login information, including password, and the updating of such on the CMS NPI website.
 Responsible for contacting physicians and AHPs to obtain their Meaningful Use status “stage and year”.
 Responsible for all registration and updates on the Meaningful Use website.
 Responsible for updating all NPI login and password information via the NPPES website.
 Responsible for updating and entry of all physician and allied health professional credentialing information into the CACTUS software system, including license, DEA, Board Certification, Specialty, practice address information.
 Responsible for updating all group addresses in CACTUS.
 Responsible for, in coordination with, physician employment coordinator updating of all contract expiration dates in Epic and CACTUS.
 Provides backup coverage to Delegated Credentialing Coordinator Senior and Provider Operations Specialist, as needed.
Requirements REQUIRED QUALIFICATIONS (Knowledge, Skills & Abilities):
Education:
 High school graduate or GED
Experience:
 5 years’ of related administrative experience in a healthcare environment
 2-3 years’ prior experience in administration of managed care programs
 Experience working accurately under time pressures
 Experience anticipating end users’ problems
Knowledge and Skills:
 Intermediate knowledge of and experience utilizing a personal computer
 Intermediate word processing and spreadsheet skills
 Basic knowledge of database software or willingness to attain such within 6 months of hire

SUPERVISORY RESPONSIBILITIES: The incumbent has no reports.

WORKING CONDITIONS: General office environment

COMPETENCIES:
 Customer Focus: Knowing the (internal and external) customer business needs and acting accordingly; anticipating customer needs, and giving high priority to customer satisfaction and customer service.
 Attention to Detail: Taking responsibility for a thorough and detailed method of working.
 Planning and Organizing: Setting priorities and defining actions, time, and resources needed to achieve predefined goals.
 Problem Solving: Having the ability to identify problems and issues of varying complexities and to find effective solutions with few guidelines.
 Initiative: Spotting opportunities within a circle of influence; anticipating threats and acting on them; self-starting rather than waiting passively until the situation demands action.
 Stress Tolerance: Performing well when faced with pressure due to time frame, workload, adversity, disappointment, or opposition.

UPG is an Equal Opportunity Employer
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