oracle
Provider Enrollment Coordinator
HealthPartners
Bloomington, USA
Junior · 2+ years experience
Onsite
Discovered 1 weeks ago
Communication
Role Overview
rankings/percentages are intended to reflect normal averages over an extended period of time, and are subject to daily variances.
Quality and efficiency standards should at no time be compromised to meet the average expectations expressed above.
Job descriptions are subject to change to accommodate organization or department needs.
Key Skills for This Role
Communication
Full Job Posting
MINIMUM QUALIFICATIONS:
- Education, Experience or Equivalent Combination:
- High school diploma or equivalent.
- 2+ years of experience in provider enrollment, medical staff services, credentialing, or revenue cycle operations.
- Knowledge, Skills, and Abilities:
- Strong knowledge of Medicare/Medicaid enrollment processes and commercial payer requirements.
- Excellent organizational skills and attention to detail.
- Ability to manage multiple deadlines and shift priorities.
- Strong communication skills and comfort interacting with providers and payer representatives.
PREFERRED QUALIFICATIONS:
- Education, Experience or Equivalent Combination:
- Associate or bachelor’s degree in business, healthcare administration, or related field.
- Experience with CAQH, PECOS, NPPES, and common credentialing/enrollment software systems.
- ESSENTIAL DUTIES:
- Provider Enrollment & Payer Management – 80%
- Enrollment consists of 10 entities and several outside contract entities.
- Prepare, submit, and track enrollment, for initial enrollment applications for MN and WI Medicare, MN and WI Medicaid, and contractual plans. Initial enrollment is based on the contractual plan requirement (profile, add/term/change form, spreadsheets, and portals).
- Prepare, submit revalidations for MN and WI Medicare, MN and WI Medicaid and commercial insurance plans.
- Reassign providers with Medicare Part A for our Critical Access Hospitals.
- Provider maintenance including name changes, terms, and change of practice locations.
- Monitor approval timelines and proactively resolve enrollment delays or discrepancies.
- Make updates to CAQH, PECOS, NPPES, and our contractual payer plans; databases.
- Re-attestation of provider data every 120 days to ensure data is accurate for the contractual plans.
- Enroll providers with out-of-state Medicaid based on state specific requirements.
- Add assigned plans codes in EPIC once confirmation is received after the provider is enrolled.
- Onboarding Support - 10%
- Collaborate closely with recruitment teams, credentialing, and Clinic Operations to ensure alignment of start dates and enrollment readiness.
- Assist providers with completing payer-required documentation and signatures.
- Serve as an enrollment subject matter expert for leadership, recruiters, and clinic teams.
- Deliver a positive, professional onboarding experience for providers
- Data Integrity & Compliance – 10%
- Ensure all enrollment processes follow federal/state regulations, payer guidelines, and organizational policies.
- Maintain accurate digital records of applications, correspondence, approvals, and effective dates.
- Support audits, quality reviews, and process improvement initiatives.
- Job description rankings/percentages are intended to reflect normal averages over an extended period of time, and are subject to daily variances. Quality and efficiency standards should at no time be compromised to meet the average expectations expressed above. Job descriptions are subject to change to accommodate organization or department needs.
About HealthPartners
Hospitals & Health Systems26000 employeesFounded 1957
Nonprofit integrated health care and insurance organization.
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