Description
Holyoke Medical Center (HMC) is an independent community hospital serving individuals and families throughout the cities and towns of the Pioneer Valley.#HMC#is a full-service hospital that provides a complete line of inpatient and outpatient medical and surgical services. We are seeking an experienced Payor Enrollment Specialist to ensure all healthcare practitioners/facilities are properly credentialed/enrolled with all contracted insurance networks and subnetworks. Understand CMS Medicare, Medicaid, and managed care billing, credentialing and enrollment requirements and reimbursement methodologies and apply knowledge to identify, quantify, and address missing/incorrect charges. Assist in the development of resources for researching issues. Duties and responsibilities will include but are not limited to: Be responsible for organizations including applications and credentialing for various practitioner#s groups and specialties for which contracting services are provided Complete audit of signed enrollment applications and required documentation for completeness and accuracy Maintain and update all credentialing systems with current information for all physicians/providers Be responsible for coordinating and maintaining all documents necessary to complete enrollment and re-enrollment of all physicians/providers/ facilities contracted with VHS Actively participate in group leadership meetings and be accountable for presenting enrollment status for all groups Resolve problems, questions, and issues internally, as well as at the payor and the practice Coordinate and facilitate troubleshooting with payor networks to resolve any issues related to enrollments REQUIREMENTS:##High School Diploma plus 2 years of experience in an office setting, preferably healthcare or insurance; experience researching issues, thinking critically, learning, and following processes, meeting multiple ongoing deadlines, and interpreting and understanding policies, rules and regulations; extensive knowledge and experience with Excel, Outlook, Microsoft office products and software programs; shows ability to learn/use software programs We offer a competitive salary # benefit package, including: low cost health insurance with no deductibles when using HMC services dental and vision insurance free disability and life insurance 403(b) plan Up to $8000 in degree/tuition reimbursement In-House Pharmacy Relaxation Room and Fitness Center Other voluntary benefits, such as LegalShield, Pet Insurance free onsite parking
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