Adventist Health is more than an award-winning health system. We provide whole-person care to our communities and champion the greater good - from the operating room to the boardroom, we are driven by our unique passion to live God's love through health, wholeness and hope. From Oregon to Oahu, we have a calling to always do more. Now is your chance to apply your passion to our mission.

We're looking for someone to join our team as a Payer Enrollment Specialist who:

Coordinates, monitors and maintains the provider enrollment and re-enrollment process in a timely and compliant manner with all government and commercial payors. Facilitates all aspects of payer enrollment, including initial enrollment, re-enrollment, and monitoring. Assists with problem identification and timely resolution of payor related issues surrounding claim submission and denial management to ensure optimal reimbursement. Serves as the liaison between managed care plans and contracted affiliates, including revenue cycle operations, to resolve any billing issues related to provider enrollment and promote optimal reimbursement.

Essential Functions:

• Processes provider applications and re-applications including initial mailing, review, and loading into the database tracking system ensuring compliance with required federal and state regulatory agencies and accrediting bodies including, but not limited to the National Committee for Quality Assurance (NCQA) and Centers for Medicare & Medicaid Services (CMS) for all health plans including Medicaid and Medicare as applicable by contracted affiliate. Completes data entry and processing of enrollment applications, with validation of provider submitted information to ensure the application is complete and accurate.
• Obtains licensure, certification and insurance certificates at time of enrollment and maintain in database in order to submit with enrollment applications. Maintains timelines on enrollment processes, and address and/or escalate any delays. Ensures that all pending enrollments are reviewed, obtained, and managed according to the rules and policies of the department. Ensures timely processing of all credentialing requests.
• Follows up with necessary contacts, including providers and managed care organizations, to resolve enrollment application issues and deficiencies. Works closely and maintain effective communication with medical directors, clinical leaders, human resources, providers and credentials committee to ensure the application process is efficient and meets established turnaround times. Works with practice operational leadership to resolve issues regarding provider enrollment issues related to credentialing and concerns. Assists with the onboarding of new providers.
• Works in collaboration with contacts in contracting, revenue cycle management, clinical operations, and other areas on issues to improve processes and outcomes. Supports risk and quality management by proactively communicating identified risks to supervisor in order to minimize risk when possible. Maintains strict confidentiality of provider and organizational information in accordance with system policy, state and federal law and regulation. Maintains appropriate documentation for each provider with each payer. Performs quality audits, as needed. Maintains and optimizes use of credentialing software and credentialing tracking tools. Maintains confidential credential files. Coordinates Council for Affordable Quality Healthcare (CAQH) files for providers to ensure completion and maintain revisions/updates. Creates and maintains national provider identifier (NPI) registry information.
• Performs other job-related duties as assigned.