Sutter Health Enrollment Coordinator-HR Physician Services Credentialing-Mountain View in Mountain View, California

Description

Job Summary:

Under minimal supervision, this position may be responsible for the following:

•Processing initial credentialing and/or recredentialing applications for PAMF, PAFMG and MPMG providers as well as contracted ancillary organizations.

•Maintaining ongoing health plan communications including directory verifications.

•Processing initial Medicare and Medi-Cal enrollment applications as well as trouble shoot enrollment related billing issues with Sutter Physician Services

(SPS) as needed.

Principal Accountabilities: Medicare and Medi-Cal Enrollment

Initiates all aspects of Medicare, Railroad Medicare and Medi-Cal enrollment process for all newly hired providers. Completes required follow up within specified timeframes to ensure successful enrollment. Every three years, will complete revalidation applications for providers selected by Medicare including appropriate follow up to ensure continued enrollment. Completion of and follow up on Medicare applications for PAMF providers that have lost their enrollment status due to the 30 day inactivity rule or have been identified on the Cred Pend Report and Claim Edit Report as needing updated documentation within specific timeframes to ensure appropriate Medicare and Medi-Cal provider enrollment.

Maintains the standard tracking log in order to stay on track, have details available to answer questions regarding status and to allow transparency of metrics.

In addition to the key accountabilities listed, employees working in this position are expected to accept and perform other duties as requested.

Qualifications

REQUIRED:

High school diploma or equivalent

Minimum of one (1) year experience in the healthcare industry

Word, Excel and Access data base experience

Ability to type a minimum of 65 wpm

PREFERRED:

College level coursework and/or degree

Two years experience in field of credentialing

6 months -2 years verification experience

6 months -2 years Basic knowledge of medical coding and terminology

Certified Provider Credentialing Specialist- CPCS

Primary Location: California, Peninsula/South Bay and Santa Cruz, Mountain View

Organization: Palo Alto Medical Foundation

Employee Status: Regular

Benefits: Yes

Position Status: Non-Exempt

Union: No

Job Shift: Day

Shift Hours: 8 Hour Shift

Days of the Week Scheduled: Monday-Friday

Weekend Requirements: None

Schedule: Full Time

Hrs Per 2wk Pay Period: 80

All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, marital status, sexual orientation, registered domestic partner status, sex, gender, gender identity or expression, ancestry, national origin (including possession of a driver's license issued to individuals who did not present proof of authorized presence in the U.S.), age, medical condition, physical or mental disability, military or protected veteran status, political affiliation, pregnancy or perceived pregnancy, childbirth, breastfeeding or related medical condition, genetic information or any other characteristic made unlawful by local, state, or federal law, ordinance or regulation. External hires must pass a background check/drug screening. Qualified applicants with arrest and/or conviction records will be considered for employment in a manner consistent with Federal, state, and local laws, including but not limited to the San Francisco Fair Chance Ordinance.