[Hiring] Revenue Cycle Payer Enrollment Specialist @Bozeman Health

Role Description

This position can be remote. Please review the approved remote states below.

• Arizona
• Florida
• Georgia
• Idaho
• Iowa
• South Dakota
• Texas
• South Carolina
• Wisconsin
• North Carolina
• Michigan

*If your state is not listed, you must relocate to Montana or one of the approved states above to be eligible for this position.

The Revenue Cycle Enrollment Specialist coordinates, completes and monitors the provider/facility payer credentialing process.

• Processes credentialing and re-credentialing applications for health care providers.
• Sends, reviews, and verifies credentialing applications.
• Loads and maintains provider information in an online credentialing database system.
• Tracks license and certification expirations for medical staff to ensure timely renewals.
• Handles and resolves inquiries regarding credentialing information, process, or status.

Qualifications

• Associate’s degree; equivalent combination of education and experience will be considered.
• Current Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Staff Management (CPMSM) by the National Association of Medical Staff Services (NAMSS) or obtained within two (2) years of hire.
• Two (2) years of healthcare experience.

Requirements

• One (1) year of payer credentialing experience (preferred).

Essential Job Functions

• Collect, review, and prepare data for final medical staff and allied health professionals “Providers” credentials review for the clinic, hospital, and payer environments and Bozeman Health “Facility” payer enrollments.
• Work with Providers and department leaders to obtain any missing information.
• Process requests for additions or changes in payer enrollment.
• Ensure that requisite licenses, malpractice coverage, and certifications are current for all Providers and Facilities.
• Perform delegated credentialing for all applicable payers and supplies applicable payers with timely provider rosters.
• Maintain files on Providers and Facilities, including information related to licensure or clinical practice disciplinary actions, clinical practice restrictions, and medical malpractice suits, judgments, and settlements.
• Provide requested reports as directed.
• Maintain current knowledge of and compliance with medical staff accreditation standards with applicable regulatory agencies and licensing standards.
• Participate in the development and implementation of credentialing policies and procedures.
• Manage payer response to re-validation for Provider and Facility enrollments to avoid any lapse in enrollment.
• Provide concise, timely communication to appropriate leadership regarding potential credentialing issues.

Knowledge, Skills and Abilities

• Demonstrates sound judgment, patience, and maintains a professional demeanor at all times.
• Exercises tact, discretion, sensitivity, and maintains confidentiality.
• Performs essential job functions successfully in a busy and stressful environment.
• Learns current and new computer applications and office equipment utilized at Bozeman Health.
• Strong interpersonal, verbal, and written communication skills.
• Analyzes, organizes, and prioritizes work while meeting multiple deadlines.
• Works varied shifts as scheduled and/or needed.

Schedule Requirements

• This role requires regular and sustained attendance.
• The position may necessitate working beyond a standard 40-hour workweek, including weekends and after-hours shifts.
• On-call work may be required to respond promptly to organizational, patient, or employee needs.

Physical Requirements

• Lifting (Rarely – 30 pounds): Exerting force occasionally and/or using a negligible amount of force to lift, carry, push, pull, or otherwise move objects or people.
• Sit (Continuously): Maintaining a sitting posture for extended periods may include adjusting body position to prevent discomfort or strain.
• Stand (Occasionally): Maintaining a standing posture for extended periods may include adjusting body position to prevent discomfort or strain.
• Walk (Occasionally): Walking and moving around within the work area requires good balance and coordination.
• Climb (Rarely): Ascending or descending ladders, stairs, scaffolding, ramps, poles, and the like using feet and legs; may also use hands and arms.
• Twist/Bend/Stoop/Kneel (Occasionally): Twisting, bending, stooping, and kneeling require flexibility and a wide range of motion in the spine and joints.
• Reach Above Shoulder Level (Occasionally): Lifting, carrying, pushing, or pulling objects as necessary above the shoulder, requiring strength and stability.
• Push/Pull (Occasionally): Using the upper extremities to press or exert force against something with steady force to thrust forward, downward, or outward.
• Fine-Finger Movements (Continuously): Picking, pinching, typing, or otherwise working primarily with fingers rather than using the whole hand as in handling.
• Vision (Continuously): Close visual acuity to prepare and analyze data and figures and to read computer screens, printed materials, and handwritten materials.
• Cognitive Skills (Continuously): Learn new tasks, remember processes, maintain focus, complete tasks independently, and make timely decisions in the context of a workflow.
• Exposures (Rarely): Bloodborne pathogens, such as blood, bodily fluids, or tissues. Radiation in settings where medical imaging procedures are performed. Various chemicals and medications are used in healthcare settings. Job tasks may involve handling cleaning products, disinfectants, and other substances. Infectious diseases due to contact with patients in areas that may have contagious illnesses.

*Frequency Key: Continuously (100% - 67% of the time), Repeatedly (66% - 33% of the time), Occasionally (32% - 4% of the time), Rarely (3% - 1% of the time), Never (0%).

The above statements are intended to describe the general nature and level of work being performed by people assigned to the job classification. They are not to be construed as a contract of any type nor an exhaustive list of all job duties performed by individuals so classified.