LifePoint Health has an opportunity for a Provider Enrollment Specialist - Hybrid in the Nashville area.

The Specialist, Provider Enrollment is responsible for requesting participation for providers in and with health plans to minimize the possibility of delay or non-payment of claims for services rendered by practitioners.

LifePoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.

ESSENTIAL FUNCTIONS: To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation.

• Complele Council for Affordable Quality Healthcare, Inc. (CAQH) credentialing process on new providers.
• Follow-up with payers for effective dates, status updates, and identification numbers for provider payment and claims to be released.
• Responsible for completing applications, re-credentialing applications, demographic updates and documents to each payer for processing.
• Research payers for information on processes to enroll providers, contact representative information; and status of provider already in the system or not.
• Update, monitor, and maintain CAQH database with all current provider information that is received from the Market Director.
• Input and/or maintain data for provider to include but not limited to, initial input of provider demographics, personal, medical documentation, effective dates, and comments.
• Maintain updated licenses, add locations and various groups.
• Monitor and maintain provider files to determine reason for pending enrollment and/or acknowledge all documents are received; request any documents and user names/passwords needed for enrollments; routinely update status changes.
• Perform routine administrative tasks to include but not limited to, processing applications, uploading and updated documents, notification forms, enroll provider(s) with all designated payers, and research process with payer in a timely manner.
• Communicate and provide updates to designated market contacts. Research payer enrollment questions and issues raised by market representative and /or providers and respond with resolution.
• Regular and reliable attendance.
• Perform other duties as assigned.

Additional Information:

Position serves both internal co-workers and external customers, clients, patients, contractors, and vendors.

Access to and/or works with sensitive and/or confidential information.

Exhibit a basic understanding of healthcare regulatory and compliance (e.g., HIPAA). Skilled in the application of policies and procedures.

Researches issues and communicates resolution to customers. Escalates issues to management when necessary.

Knowledge of Business Office Standards and Recommended Practices.

BENEFITS:

At LifePoint, our Mission of Making Communities Healthier extends to our employees. We offer an excellent total compensation package, including a competitive salary and benefits. Some of our benefits include 401k, flexible PTO, generous Employee illness benefit (EIB), medical, dental, vision, tuition reimbursement, and an Employee Assistance Program. We believe that happy, healthy people have a passionate engagement with life and work and have designed our package to enhance your wellbeing.

KNOWLEDGE, SKILLS & ABILITIES: The requirements listed below are representative of the knowledge, skills and/or abilities required.

Education: High School Diploma or GED equivalency.

Experience: Minimum of 2 years. Experience in Insurance Payer Background and/or Enrollment preferred.

Minimum overnight travel (up to 10%) by land and/or air.