Provider Enrollment Coordinator

Location Address:

Compensation Pay Range:

Summary:

Responsibilities:

• Provides consultative support to PMG providers and sites on enrollment processes, licensing, and payer requirements, maintaining current knowledge of regulatory standards. Assists the department manager with delegated payer audits and maintains provider enrollment files in compliance with NCQA and confidentiality requirements.
• Reviews practitioner applications and credentials to generate accurate enrollment packets. Collaborates with Provider Navigators, Medical Staff Affairs, Presbyterian Health Plan, CVO staff, contracting, and billing teams to identify new providers, determine required health plan enrollments, and communicate PINs and taxonomy updates.
• Processes all provider changes (e.g., pointage, specialty, function, terminations) and completes required payer applications. Performs audits using Cactus reports, risk management term reports, payer reports, and internal file reviews.
• Manages monthly updates and uploads of the Provider Directory, credentialing grid, and newprovider status reports. Assists in training new staff and contributes to developing and revising departmental policies, procedures, criteria, audit tools, and desktop manuals.
• Conducts denial management for assigned providers, reviewing writeoff and denial reports, escalating issues as needed, and following up on outstanding claims. Handles purging and preparation of termed provider files for scanning.
• Investigates and resolves customer complaints from EWC related to assigned providers. Serves as departmental representative and point of contact for contracted payer meetings.

Qualifications:

• Associates Degree preferred or at least three years of experience in a medical, business or medical staff affairs office required.
• Possess strong interpersonal skills and able to relate positively to health care providers.
• Possess basic computer skills including use of Windows, MS Office and Outlook.
• Claims processing and medical terminology experience a plus
• Essential Education : High school diploma
  

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.

Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.

Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.

About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.