Spec, Provider Enrollment - Collegeville, PA req29984 in Collegeville, PA at Quest Diagnostics

Date Posted: 8/7/2019

Job Snapshot

Job Description

Spec, Provider Enrollment- Collegeville, Pennsylvania or Addison, Texas  (Monday through Friday)

We Provide Solutions.  Patients and Physicians rely on our diagnostic testing, information and services to help them make better healthcare decisions. These are often serious decisions with far reaching consequences, and require sensitivity, tact and a clear dedication to service. It’s about providing clarity and hope. 

In Commercial Contracting,  you will work for the world leader in the industry, with a career where you can expand your skills and knowledge. You’ll have a role where you can act with professionalism, you can inspire colleagues, and you can care about the work we do and the people we serve.  Working across a strong customer base, you’ll find you have the flexibility and autonomy to structure your days while having the confidence that comes from promoting a well-recognized and trusted brand.

Basic Purpose:
Manage, monitor and complete activities related to Provider Enrollment applications, revalidation updates and Credentialing applications as required by the Centers of Medicare & Medicaid Services (CMS) Department of Health (DOH) for Medicare, Medicaid, and Health Plan payers, for Quest, Diagnostics, its subsidiaries, joint ventures and their respective testing facilities. Drive process compliance, controls and standardization utilizing a Centers of Excellence methodology and tools to support and track all Provider Enrollment activities.  

Duties and Responsibilities:

  • Review, prepare and submit requests for Medicare, Medicaid, and Health Plan payers to include completion of but not limited to: provider enrollment applications, revalidation requests, NPI enrollments, licensure updates, CAQH physician credentialing, health plan credentialing, attestations, and disclosures of ownership
  • Engage with stakeholders such as Health Plans, Legal, Business Development, Compliance, Laboratory Operations and Optum to successfully complete enrollment requests and related activities  
  • Engage with payers directly to discuss enrollment issues, inquiries, updates and due dates of enrollment applications
  • Review and monitor credentialing reports of enrolled physicians, facilities, and provider groups to proactively submit credentialing applications in advance of payer defined enrollment/re-enrollment deadlines. 
  • Perform regular updates/additions to the Provider Enrollment Database to ensure enrollment reference data is up to date in advance of the enrollment process
  • Manage all enrollment activities using worklists in a centralized web-based application such as CRM and finalize the signature process through established state Medicaid web portals and the DocuSign eSignature tool.
  • Accurately and efficiently submit enrollment and credentialing applications  
  • Effectively manage and update status of enrollments by way of case creation and management
  • Effectively communicate with agencies, health plans and internal stakeholders’ on status of enrollments and credentialing applications

Supervision Exercised:  N/A

Qualifications:
Education Preferred: Bachelor’s Degree Preferred

Work Experience: 

  • 3 + years' relevant experience, including working knowledge of Medicare and Medicaid provider network requirements or health plan payer enrollments
  • Relevant experience in large, complex organizations, commercial lab, or healthcare organizations

Other: 

  • Strong analytical and problem-solving skills
  • Strong interpersonal skills; ability to work with external clients and multiple levels internal
  • Ability to handle confidential or sensitive information with discretion
  • Strong written & verbal communication 
  • Strong attention to detail
  • Strong technical skills in MS Word and Excel
  • Able to multi-task and perform in a fast-paced environment
  • Lominger’s Competencies:
  • Customer Focus
  • Organizational Savvy
  • Learning on the Fly
  • Problem Solving
  • Dealing with Ambiguity
  • Drive for Results

All requirements are subject to possible modifications to reasonably accommodate individuals with disabilities. Quest Diagnostics is an Equal Opportunity Employer: Women / Minorities / Veterans / Disabled / Sexual Orientation / Gender Identity or Citizenship

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