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Provider Enrollment Specialist - GA Heart Institute - Full Time Days

Company: Northeast Georgia Health System, Inc
Location: Gainesville
Posted on: May 12, 2024

Job Description:

Job Category:Administrative & Clerical Work Shift/Schedule:8 Hr Morning - AfternoonNortheast Georgia Health System is rooted in a foundation of improving the health of our communities. About the Role:Job SummaryUnder the direction of the Practice Administrator, performs Medical Staff and Allied Health Professional credentialing. Ensures integrity of credentialing database. Works cooperatively with Practitioners and office staff to facilitate the credentialing process. Functions as an intricate part of the Medial Staff Services team. Performs projects as assigned. Minimum Job Qualifications

  • Licensure or other certifications:
  • Educational Requirements: High School Diploma or GED.
  • Minimum Experience: Two (2) to three (3) years experience in Credentialing services. Two (2) years college or equivalent experience will be considered in lieu of experience.
  • Other: Preferred Job Qualifications
    • Preferred Licensure or other certifications: Provider Credential Specialist.
    • Preferred Educational Requirements:
    • Preferred Experience:
    • Other: Job Specific and Unique Knowledge, Skills and Abilities
      • Experienced enrolling providers in the Medicare and Medicaid programs
      • Strong written and verbal communication skills and the ability to communicate effectively with people on all levels. Possesses strong organizational and professional communication skills
      • Ability to function as part of a team
      • Ability to handle a variety of situations and perform under deadlines Essential Tasks and Responsibilities
        • On an on-going basis prepares and submits Medicare and Medicaid provider enrollment and revalidation applications for NGPG physicians and mid-level providers including Heart center providers.
        • Verifies all supporting documents that are needed for enrollment are received from recruitment and are legible, current and completed correctly. Follows up with the provider, the credentials verification office an /or recruitment to secure missing documents and/or to provide further clarification. Enters valid practitioner npi login credentials into Apogee.
        • Monitors provider non-compliance with enrollment requests and notifies management of delays that can impact reimbursement.
        • Follows up on document request from Medicare and Medicaid. Retains communication for reference purposes.
        • Monitors timely receipt of approvals and follows up as necessary. Enters effective dates and provider numbers on a the payor grid or other organizational document as directed. Scan approval letters to the established efile and notifies key personnel.
        • Responsible to maintain the NGPG entity records in Medicare ( GRP 4221 & 7942), including revalidations for both NGPG and NGPG-urgent care for Medicare and Medicaid.
        • Responsible to update each practitioner's personal NPPES profile as authorized by each provider.
        • Responsible for Physician /Mid-level Data
        • Assist provider with initial process for obtaining medical license and GA DEA as needed
        • Coordinate with NGMG Medical Staff Services and other required facilities to provide documentation for the credentialing and clinical privileging of all MDs and mid-levels
        • Coordinate with Insurance Agent/preparation of Malpractice Application to ensure provider is added to coverage
        • Ensures PA records are updated with the state with any/all changes in sponsoring physicians/alternate physicians when working due to provider services at numerous facilities
        • Prepare Nurse Protocol Agreements, coordinate submission to the State of Georgia in a timely manner that will coincide with scheduled board meetings to ensure the approval of the Delegated/Designated physicians who will be responsible for each mid-level
        • Manage License Renewals for all MDs and Mid-levels
        • Manage DEA Renewals for all MDs and Mid-levels
        • Manage ACLS/BCLS Renewals for all MDs and Mid-levels
        • Maintain CME records and provide when needed to ensure accreditation requirements are met. Provide CME credits to all facilities when re-approaching each physician.
        • Additional duties as assigned. Physical Demands
          • Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time
          • Weight Carried: Up to 20 lbs, Occasionally 0-30% of time
          • Vision: Moderate, Occasionally 0-30% of time
          • Kneeling/Stooping/Bending: Occasionally 0-30%
          • Standing/Walking: Occasionally 0-30%
          • Pushing/Pulling: Occasionally 0-30%
          • Intensity of Work: Occasionally 0-30%
          • Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. NGHS: Opportunities start here. Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.

Keywords: Northeast Georgia Health System, Inc, Atlanta , Provider Enrollment Specialist - GA Heart Institute - Full Time Days, Other , Gainesville, Georgia

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