The Payer Enrollment Coordinator is responsible for timely completion of initial and re-credentialing insurance enrollments for all providers (licensed independent practitioners (LIP), other licensed or certified practitioners (OLCP), and other clinical staff (OCS)). Additionally, this role will research payer credentialing and billing issues and work in conjunction with the Revenue Cycle Manager to identify and resolve issues with provider enrollments. This position requires frequent contact with human resources, clinic leadership, providers, and payers.

Payer Enrollment/Credentialing

Work closely with human resources on notification of a provider's start date, welcome packets, provider documentation and ensuring the provider is in all systems. Responsible for obtaining provider delegation and signatures to maintain external credentialing databases. Researches and resolves billing holds with insurance carriers in Epic. Performs timely follow-up with insurance payers via phone, email or website to resolve payer credentialing and billing issues. Manage the completion and submission of provider enrollment and re-enrollment applications. Perform tracking and follow-up to ensure provider numbers are established and linked to the appropriate location in a timely manner and all payer directories are current. Maintain trackers and rosters with current information on enrollment status. Understand and maintain documentation for specific application requirements for each payer including pre-requisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.) and regulations. Maintain documentation and reporting regarding provider enrollments in process. Setup and maintain providers in the Center for Medicaid/Medicare Services Identity and Access System.  Maintain and update National Plan and Provider Enumeration System, the Council for Affordable Quality Healthcare’s (CAQH) database of provider information, and the Provider Enrollment Chain of Ownership System, submitting initial enrollments and revalidations in a timely manner and always by due dates. Process and maintain civil surgeon/INS applications. Retain records related to completed payer credentialing applications in provider credentialing files in collaboration with human resources. Work closely with clinic personnel, providers, and billing to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc. Establish close working relationships with privileging personnel, providers, payer provider representatives, and other stakeholders. Performs other duties and special projects as assigned. 

Site Credentialing

Maintain and update National Plan and Provider Enumeration System and the Council for Affordable Quality Healthcare’s (CAQH) database for new and existing sites. Notify all insurers of new site(s) and assign appropriate providers. Notify insurers of site closures and reassign appropriate providers.

Work Experience:  Minimum of one year healthcare experience. Previous payer enrollment and familiarity with payer portals preferred. 

Education, certification and licensure:   High school graduate or equivalent required. Associate’s degree in a related field required or in lieu of degree, a combination of equivalent education and work experience. 

Skills & Knowledge:  Must demonstrate computer and software skills using spreadsheets including data input, data filtering, sorting, and organization, creating, maintaining, and formatting workbooks, Adobe fillable documents, DocuSign, Word documents, and Outlook. Knowledge of HIPAA and confidentiality. Excellent organization skills with high degree of attention to detail. General office skills including use of e-fax, email, filing and retrieving from a share drive, instant messaging, copier and phone system.  Works independently and follows through on tasks timely, consistently meeting deadlines. Excellent verbal and written communication skills and customer service orientation. Must possess be comfortable communicating frequently with providers.

Who We are

Mosaic Community Health prides itself on being an innovative health system that pioneers unique and creative ways to provide and improve patient access to health care. Since our founding in 2002 we have proudly served insured and uninsured patients regardless of age, ethnicity, or income.

We focus on a holistic approach to patient care by incorporating behavioral health, pharmacy, and nutrition support to serve patients in the most meaningful way. At Mosaic Community Health, you will work with incredibly dedicated and mission-centered peers and be part of a dynamic team based environment.

Mosaic Community Health offers more than just a job, it is a lifestyle. A lifestyle of serving others. A lifestyle of being an integral part of your community. A lifestyle that offers work/life balance. A lifestyle of enjoying the outdoors! Central Oregon offers over 300 days of sunshine a year, so enjoy a PTO day on the mountain, biking/hiking trails, or the river! A lifestyle that improves lives, including yours. Of course, we also offer a great benefit package!