Enrollment Services Coordinator I

Responsibilities:

• Works with providers, departments, and Professional Billing Office staff to complete provider enrollment process in a timely and efficient manner in accordance with service standards.
• Works with health plan staff to ensure their information needs are met and that they provide provider numbers on a timely basis.
• Completes, submits and follows up on managed care exports and/or indemnity or Behavioral Health applications sent to the assigned health plans for enrollment into their network.
• Ensures that provider and practice changes are submitted to the assigned health plans and are accurately processed by the health plans.
• Performs special projects and/or run reports to support the provider enrollment process for the assigned health plans.
• Maintains proficiency in utilization of enrollment databases and other systems required for enrollment with assigned health plans (e.g. PECOS, Promise, Navinet, CAQH, Health Plan Portals).
• Serves as liaison between the departments/practices and health plans in order to resolve enrollment issues.
• Analyzes the various Enrollment Reports for assigned plans to ensure that the providers’ enrollments have been completed with the health plans.
• Researches department/practice complaints and/or independently identifies data errors/inconsistencies and other problem areas with enrollment database and resolves or refers issues to manager as appropriate.
• Performs duties in accordance with Penn Medicine and entity values, policies, and procedures.
• Other duties as assigned to support the unit, department, entity, and health system organization UPHS Organizational

Education or Equivalent Experience:

• H.S. Diploma/GED (Required).
• 2+ years of experience working in a similar position required, preferably in a health care organization (Required).

Skills & Abilities:

• Ability to use Microsoft Word, Excel, and Outlook.
• Must have the ability to maintain information in a confidential manner in accordance with all regulatory requirements.
• Must be able to work independently, take initiative and persevere in obtaining application documentation while communicating in a professional manner.
• Must have an understanding of government (Medicare/Medicaid), Managed Care or Behavioral Health plan enrollment policies and procedures.
• Must be able to work effectively as a member of a team.
• Must be able to meet deadlines.
• Must be able to exercise good judgment when escalating issues.
• Must demonstrate strong communication skills - verbal/written - with providers, internal customers and external contacts.