Payor Enrollment Coordinator- PAA - Nationwide Children's Hospital

Overview:This position serves as a primary contact within the Payor Enrollment team at Nationwide Children’s Hospital’s for multispecialty medical groups regarding provider enrollment with various health plans.  Collaborates with physicians, nurse practitioners, operational managers, department administrative support staff, and health plans to ensure providers are actively enrolled with contracted health insurance companies.  Collaborates with the Medical Staff Office to ensure providers are properly enrolled with contracted payors once they begin employment. Also collaborates with PFK (Partners for Kids) and Payor Relations staff to ensure a stream-lined approach across continuum of payors. Works with highly confidential information under minimal supervision.Why Nationwide Children's Hospital?:

The moment you walk through our doors, you feel it. When you meet our patient families, you believe it. And when you talk with anyone who works here, you want to be part of it. Welcome to Nationwide Children’s Hospital, Where Passion Meets Purpose.

 

Here,Diversity, Equity and Inclusion are integrated into our core values and practices. We are passionate about building, sustaining and evolving an inclusive and equitable environment. We are seeking individuals who live these values and want to share their experiences and efforts in support of our collective mission.

 

We’re 14,000 strong. And it takes every one of us to improve the lives of the kids we care for, and the kids around the world we’ll never meet. Kids who live healthier, fuller lives because of the knowledge we share. We know it takes a Collaborative Culture to deliver on our promise to provide the very best, innovative care and to foster new discoveries, made possible by the most groundbreaking research. Anywhere.

 

Ask anyone with a Nationwide Children’s badge what they do for a living. They’ll tell you it’s More Than a Job. It’s a calling. It’s a chance to use and grow your talent to make an impact that truly matters. Because here, we exist simply to help children everywhere.

 

Nationwide Children’s Hospital. A Place to Be Proud.

Responsibilities:Payor Enrollment

 

1. Coordinates the payor enrollment function for physicians and nurse practitioners for payors not delegated.
2. Prepares payor enrollment packets for new physicians, nurse practitioners, certified registered nurse anesthetists, genetic counselors, pathologists, dentists, and physician assistants prior to their employment.  Sends packets to health plans and does appropriate follow-up.  Notifies health plans of termination of provider participation as needed.  Maximizes use of online applications to expedite processing time.
3. Educates providers regarding the processes of registering with the Federal Credential Verifications Services, obtaining Ohio medical license/DEA, and obtaining Medical Staff privileges.
4. Validates Council for Affordable and Quality Healthcare (CAQH) profile for each physician every 90-120 days and uploads certifications quarterly. Annually uploads liability information on all providers.
5. Maintains a file of all relevant payor enrollment-related information for each physician, including current Curriculum Vitaes and skill-set certifications (ex: PALS). 
6. Responsible for updating all assigned providers in SharePoint to provide all parties with status update for enrollment process.
7. Serves as a liaison with Division/Section Chiefs, Service Line Administrators, and PAA Administration to provide status updates.
8. Tracks the following items: status level of privileges at NCH and other hospitals, malpractice coverage history for each physician, status of enrollment with various payors.
9. Provides updates to the Professional Billing Department regarding new provider ID numbers; notifies EPIC team regarding newly hired physicians, leased providers and notifies PFK, Medical Staff Office, and health plan carriers regarding termination of physicians.
10. Provides training of the payor enrollment process and serves as a mentor.
11. Works with external hospital medical staff offices to provide direction and information as needed for providers who apply or have privileges at the specific hospital affiliations.

 

Malpractice

 

1. Serves as a liaison with NCH Legal Services to coordinate the activation of malpractice coverage once a physician is hired.  Serves as a reporting resource for potential malpractice suits.
2. Reviews information such as 180-day letters, summons and complaints and handles accordingly.  Tracks and monitors current status of malpractice cases. 
3. Obtains, monitors, and reviews loss runs from Insurance and Claims Paralegal on a quarterly basis to ensure cases are entered into CAQH profile of providers.
4. Drafts malpractice coverage letters for physicians and allied health providers on an annual basis.
5. Upon request, provide malpractice carrier history and contact information to providers who have terminated.
6. Orients new physicians on procedures of reporting malpractice related information to Legal Services.

 

Professional Billing

 

1. Strives to find solutions to operational issues effecting accounts receivable and/or customer service.
2. Collaborate with Nationwide Children's Hospital EPIC team by providing imports with new provider information regarding bill area, specialty and default.
3. Improve the accounts receivable and collection process to maximize cash flow for NCH’s multispecialty medical groups.
4. Strives to find solutions to operational issues affecting accounts receivable and/or customer service.
5. Provides Patient Accounts with provider numbers on everyone who bills for NCH’s multispecialty medical groups.
6. Effectively communicates and collaborates with Patient Accounts and Professional Billing, Coders and Patient Account Representatives to ensure successful work flow of claims and corrective actions.
7. Leads and contributes to other projects and initiatives as directed by PAA Operations Manager.

Qualifications:KNOWLEDGE , SKILLS AND ABILITIES REQUIRED

1. An Associate’s or Bachelor degree in business, health care administration preferred; or equivalent professional experience in payor enrollment;
2. Excellent communication skills, both verbal and written, as well as strong organizational and analytical abilities;
3. Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization;
4. Ability to work independently with minimal supervision.
5. Ability to research/analyze data, organize and prioritize work, and manage multiple priorities;
6. Ability to identify opportunities and solutions for process improvement and implement those solutions;
7. At least three to five years provider payor enrollment experience;
8. One to three years of medical terminology experience or medical background preferred;
9. Basic typing skills and working knowledge of Microsoft Office Applications. Experience with credentialing software programs preferred;
10. Knowledge of various organizations and database used in payor enrollment and hospital credentialing, including CAQH’s Universal Provider Database, FCVS, State Licensing Boards, and skill-set certifications.  Able to navigate through complex and large organizations.
11. Previous medical billing experience desired.

MINIMUM PHYSICAL REQUIREMENTS Typing on computer Frequently (34-66%) Using phone Frequently (34-66%) Sitting Frequently (34-66%) Standing Occasionally (0-33%) Lifting Occasionally (0-33%) Walking Frequently (34-66%)

 

The above list of duties is intended to describe the general nature and level of work performed by individuals assigned to this classification. It is not to be construed as an exhaustive list of duties performed by the individual so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct, and control the work of employees under his/her supervision.

 

EOE M/F/Disability/Vet