Job Description

JOB IS LOCATED IN WICKENBURG, AZ

Wickenburg Community Hospital is a beautiful and sophisticated rural-access hospital located in Wickenburg, Arizona.  WCH is a 8-bed Emergency Department, 19-bed Acute department and many ancillary services.  We also have 3 Primary Care Clinics.  Here at WCH, we strive to maintain the highest standards of professionalism and care.  Join us today and let us be part of your success story.

We offer:

  • Full Benefits
  • PTO/Sick Leave
  • Wellness Benefits

Wickenburg Community Hospital is a non-profit organization and qualifies for the Public Service Loan Forgiveness (PSLF) program.

General Description

Provider Enrollment Representative will be responsible for the administration of the provider enrollment process for assigned new and existing providers. You'll also be responsible for assisting in obtaining and maintaining information essential to complete the credentialing/re-credentialing process.

Essential Job Duties

  • Build knowledge base for payor requirements and forms.
  • Obtain required credentialing paperwork from insurance companies.
  • Coordinate delivering provider applications to appropriate health plans.
  • Submit applications to payers.
  • Follow-up and check status of applications with payers
  • Reviews and screens initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, and local guidelines, policies, and standards.
  • Conducts primary source verification, collects, and validates documents to ensure accuracy of all credentialing elements; assesses completeness of information and qualifications relative to WCH credentialing standards.
  • Identifies, analyzes, and resolves extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners.
  • Monitors files to ensure completeness and accuracy; reviews all file documentation for compliance with quality standards, accreditation requirements, and all other relevant policies; prepares and provides information to internal and external customers as appropriate.
  • Enters, updates, and maintains data from provider applications into credentialing database, focusing on accuracy and interpreting or adapting data to conform to defined data field uses, and in accordance with internal policies and procedures.
  • Prepares, issues, electronically tracks and follows-up on appropriate verifications for efficient, high-volume processing of individual applications in accordance with applicable credentialing standards, established procedural guidelines, and strict timelines.
  • Participates in the development and implementation of process improvements for the system-wide credentialing process; prepares reports and scoring required by regulatory and accrediting agencies, policies, and standards.
  • Communicates clearly with providers, their liaisons, entity Medical Staff Affairs. medical staff leadership and Administration, as needed to provide timely responses upon request on day-to-day credentialing and privileging issues as they arise.
  • Performs miscellaneous job-related duties as assigned.

Other (Non-Essential) Job Duties

  • Ability to communicate effectively both orally and in writing.
  • Customer service skills.
  • Ability to respond to emails timely and effectively.
  • Information research skills.
  • Working knowledge of clinical and/or hospital operations and procedures.
  • Ability to maintain confidentiality and discretion in all communications on behalf of credentialing applicants and/or applications.
  • Ability to make administrative/procedural decisions and judgments.
  • Demonstrated advanced working knowledge of Microsoft Word and Excel.
  • Skill in establishing priorities with independent coordination of day-to-day aspects.
  • Advanced skills in computerized spreadsheet and database management.

Minimum Qualification

  • High school diploma or GED
  • Completed degree(s) from an accredited institution that are above the minimum education requirements may be substituted for experience on a year for year basis.

Preferred Qualification

  • 2+ years of experience directly related to the duties and responsibilities specified.
  • Maintain high levels of organization while being extremely focused on detail.
  • Be able to efficiently use necessary computer software applications (ie.,Excel, Word, Outlook
  • Must be able to prioritize projects.
  • Must maintain composure and professionalism under circumstances that may become stressful.
  • Intrapersonal and team-building skills

Physical Requirements / Working Conditions

  • Frequent standing, stooping, bending, stretching, squatting; must be able to stand/walk for most of the workday; heavy lifting, must be able to lift packages up to 75 pounds
  • Must be able to work paying close attention to detail with frequent interruptions
  • Ability to work in a fast pace environment