Job Information

AdventHealth Enrollment Specialist - Managed Care in Altamonte Springs, Florida

Description

AdventHealth Corporate

Location Address: Virtual, local to Central Florida

All the benefits and perks you need for you and your family:

  • Benefits from Day One

  • Career Development

  • Whole Person Wellbeing Resources

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Full-Time

The role you’ll contribute:

Responsible for physician systems including applications and credentialing for various physician groups and specialties for which contracting services are provided. Maintains and updates all credentialing systems with current information for all physicians/providers. Responsible for coordinating and maintaining all credentialing documents necessary to complete credentialing and re-credentialing of all physicians/providers for which we contract. Responsible for auditing and data analysis for all physician/provider credentialing records, documents and files. Responsible for programming Apogee applications to generate reports necessary to ensure accuracy of physician/provider records. Actively participates in physician group leadership meetings and is accountable for presenting credentialing status for all groups. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

The value you’ll bring to the team:

  • Responsible for the credentialing efforts for primary care and/or specialist physician and/or mid-level providers employed by AHS Florida Division physician groups.

  • Responsible for understanding and utilizing the functionality of Apogee (or any subsequent credentialing database) and training new employees.

  • Responsible for programming physician/provider applications within Apogee (or any subsequent credentialing database) and works.to ensure physician/provider information is complete, accurate, and up to date.

  • Ensures that credentialing applications are scanned and programmed to populate with physician information.

  • Assists in maintaining a complete database (including CAQH) of all credentialing materials for all employed physicians/providers.

  • Utilizes advanced level of skill relating to the understanding of payer credentialing nuances and disseminates such information and trains team members as necessary.

  • Communicates with physician/provider office staff and practice management regarding the status of applications, additional materials required, etc.

  • Educates physician/provider and physician/provider leadership staff on necessary documentation needed in order to credential physician/provider.

  • Responsible for ensuring that all documents are up to date and new documents are requested from practice management for any that may be expiring.

  • Effectively communicates and is accountable to staff, leadership, payors, providers, patients, and visitors.

  • Effectively participates and plays an integral role in meetings and discussions with regional leadership to include Managed Care Directors, Physician Group Leadership and staff in regard to internal issues, physician onboarding issues and payer issues.

  • Deals with patient information in a sensitive manner to ensure respect and privacy for patient and expeditious handling of related issues.

  • Supports the Credentialing Manager and Director of Credentialing and Revenue Management by resolving problems, questions, and issues internally, as well as at the payer and the practice.

  • Supports physician contracting and operation services by auditing and analyzing data, verifying applications, preparing amendment letters, ensuring physician/provider credentialing materials are processed efficiently, professionally and as expeditious as possible. Researches any inconsistencies or discrepancies as assigned by leadership and educates entire team of findings.

  • Supports the contracting team, internal departments, ancillaries, and physician groups, and owned PHOs as applicable, to assist with, identify, and resolve operational, accounts receivable, utilization management, quality assurance, billing and other related issues.

Qualifications

The expertise and experiences you’ll need to succeed:

  • High school diploma or equivalent

  • Minimum of four years’ experience in healthcare; preferably in managed care, provider credentialing, patient financial services or provider relations

  • Spreadsheet experience

  • Microsoft Word, Excel, PowerPoint, Access, Outlook

  • Data Entry

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

Category: Population Health

Organization: AdventHealth Corporate

Schedule: 1 - Day

Shift: AdventHealth

Req ID: 22023704

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.