Mission

To inspire health and healing by putting patients first - ALWAYS.

Position Summary The Payer Enrollment Coordinator is responsible for coordinating all of the functions related to enrollment with payers of individual physician and non–physician providers (employed or community based), the organization and for providing assistance in coordinating enrollment for hospital privileges and payer credentials related to outreach clinics. Additional responsibilities include: initiating and maintaining the providers CAQH data base, committee meetings, credential files, and quality assessment logs. Provides occasional administrative support to the Physician Services staff. Minimum Qualifications Education High School degree or equivalent required. Associate degree in administrative or medical office studies preferred. Credentials None Physical Demands Stands and/or walks two hours per day. Sits six hours per day. Bends, reaches and stoops daily. Visual acuity, ability to speak and hear, manual dexterity and eye-hand-foot coordination required. Ability to drive an automobile required. Essential Functions Coordinate the payer credentialing enrollment process for all CIN providers. Organizes and maintains payer credentialing files and assure all data/documents are kept confidential. Coordinate with clinic managers, providers and the Medical Staff office to gather provider information and signatures for enrollment forms. Coordinate and oversee the credentialing of payors for individuals providers (independent) and the organization (employed). Verify medical and/or professional education, fellowships, relevant board certifications, health care affiliations, work history, licensure and certifications, DEA certificates, malpractice coverage for the purpose of submitting applications and re-applications to payors and Nebraska Health Partners. Maintain payor credentialing databases and rosters assuring accuracy and completeness. Maintain familiarity with the policies of Nebraska Health Partners, CMS, Medicaid relating to the payor credentialing process. Serve as liaison between Nebraska Health Partners and CIN clinics to assure providers have continuous membership with the various payors.

Manage and maintain the CAQH database for all employed GPH providers.

Work with Revenue Cycle/Clinical staff to complete investigation and/or answer inquires relating to providers reported out of network.