Credentialing and Payer Enrollment Specialist

Every day we provide vital information that helps our clients and patients understand their health. Our team of expert pathologists believe in a collaborative approach to patient care centered on outstanding quality diagnostics and service to the Northwest medical community. Not only do we bolster our community, but we also provide numerous resources to our employees which help bring balance to the complexities of work and personal life through our wellness programs. If you are motivated about helping people and have a drive for service, then Incyte Diagnostics could be a great next career step!

About the Role: We are seeking a highly organized and detail-oriented Credentialing & Payer Enrollment Specialist to join our team. The successful candidate will be accountable for data collection, organization and submission of applications required by health plans, hospitals and governmental and other regulatory agencies. Works closely with individual practitioners, organizational leadership, Affiliated Hospitals Medical Staff, Payer’s Provider Relations Staff, Human Resources, and Billing Department to facilitate timely hospital credentialing and privileging, payer enrollment and re-enrollment, as well as expirables (state licenses, DEA, Board Certification, malpractice insurance, etc.), as required by governmental agencies and accreditation bodies.

You Will:

• Maintain Credentialing and Payer Enrollment of Incyte Diagnostics’ Pathologists
  • Successfully oversees the entire payer enrollment process through Pathologist’s onboarding (start date) and off boarding (exit date) (physician life cycle with Incyte)
  • Maintains timelines enrollment schedules, communicates with Pathologist and other departments to update as needed, clarifies information requirements with internal and external stakeholders, and maintains strict level of confidentiality to provider information.
  • Oversees the collection, tracking, verification, and maintenance of all pathologists’ information needed for enrollment, provider demographic updates, Incyte Diagnostics’ demographic updates, and payer contracting requirements. Payer Enrollment data includes but not limited to Medicare, Medicaid, private/commercial, and worker’s compensation payers electronic or paper enrollment and re-enrollment applications; licensure, certifications, and hospital affiliations; peer references & work history; practice
• Provide Administrative Support & Human Resources Support
  • Provides back-up for production and interpretation of pathologists' schedules, complying with corporate guidelines regarding time off, staffing, etc.; is able to determine staffing needs to resolve staffing issues, etc.
  • Assist with travel needs for current and interviewing pathologists.
  • Assist with new pathologist Onboarding to include communication with pathologist(s), scheduling onboarding meetings with staff and coordinating hospital orientations.
  • Management of small hospital lab visit to include scheduling and production/distribution of reports of visit.
• Verify and maintain accurate provider information in compliance with industry regulations
  • Successfully oversees the entire hospital credentialing process through Pathologist’s onboarding (start date) and offboarding (exit date) (physician life cycle with Incyte)
  • Maintains timelines credentialing schedules, communicates with Pathologist and other departments to update as needed, clarifies information requirements with internal and external stakeholders, and maintains strict level of confidentiality to provider information.
  • Oversees the collection, tracking, verification, and maintenance of all pathologists information needed for credentialing, provider demographic updates, contracting, and other platforms as applicable. Credentialing data includes but not limited to education, post graduate training, sanctions (licensures; Medicare/Medicaid), work history, medical staff membership, peer references, NPI, licensures, DEA, Board Certification, CV, malpractice insurance, hospital privileges, activity reports and current clinical competence/ability to perform, continuing medical education (CME) and self-assessment modules (SAM), etc.
• Collaborate with medical professionals to ensure that all medical claims are processed accurately and efficiently
• Maintain up-to-date knowledge of industry regulations and requirements
• Communicate with healthcare providers to obtain necessary information and documentation

Education / Skills:

Minimum Qualifications

• Associate Degree or high school diploma equivalent
• Two – three years’ experience in provider credentialing, payer enrollment, healthcare, or general office experience
• Must be highly organized, motivated self-starter with impeccable attention to detail.
• Must work with a sense of urgency and demonstrate the ability to prioritize and work effectively under pressure.
• Possess excellent communication skills (written, presentation, listening, and oral)
• Proven ability to interact with physicians and support staff.
• Evidence of ability to coordinate multiple projects and tasks of medium complexity. Advanced proficiency in Microsoft Office programs
• Takes initiative and works independently with minimal guidance. Ability to demonstrate excellent customer service.
• Ability to demonstrate problem solving skills.

Preferred Qualifications

• Bachelor’s Degree in Health Care Administration or equivalent
• Certified Provider Credentialing Specialist (CPCS) OR meet requirements to become certified within 6 months of hire.
• Working knowledge of Joint Commission Standards, NCQA Standards, FCVS, obtaining medical licensures, CAQH, OneHealthPort, PECOS (Medicare), AMA, PECOS and primary data source verifications.
• Familiarity with electronic medical records systems.

Pay Range: $21.21 - $29.70 USD Hourly Annual The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Generally, new hire offers will be between the minimum and midpoint of the salary range, depending on experience (DOE), with the ability to grow within the range over time.

For other opportunities, at Incyte Diagnostics: https://www.incytediagnostics.com/about/careers/