• Job Description

  Req#: 3029363

  Provider Enrollment Analyst-Billing-Full Time-Day-Mount Sinai Queens

  The Provider Enrollment Analyst (I) is responsible for completion of all provider insurance credentialing and re-credentialing functions, including meeting requirements for government, commercial, managed care, and other health plan credentialing following an industry-standard manner.

  Qualifications

  • Education: Bachelor's degree strongly preferred, or equivalent years of Provider/Facility Enrollment or credentialing experience and Associates degree. Medical Group and Health Plan knowledge preferred.
  • Experience: Two years minimum of healthcare experience including Medicare or Medicaid Provider or Facility Enrollment or Credentialing experience required, including one year of revenue cycle-specific as well as direct customer service.

  Non-Bargaining Unit, 264 - Professional Billing - MSQ, Mount Sinai Queens

  Responsibilities

  • Ensure enrollments for new providers in Medicaid, Medicare, Managed Care plans, Commercial Health plans and Exchange plans.
  • Identify enrollment disparities for existing and new providers, work with plan to correct errors.
  • Work directly with MSQ Departments to ensure compliance with Medicare & Medicaid enrollment. Ensure that Annual Medicaid Decertification Forms are filled and completed accurately prior to the expiration deadline.
  • Collect physician’s credentials & signatures for paper applications.
  • Manages and collaborates with external departments to ensure the procurement, timely completion and submission of required Federal and State forms as received from the CBO/FPA, establishing continuous coverage and reimbursable status for MSQ PB.
  • Respond to requests from departments & insurance representatives regarding TIN linkage, enrollment status & physician demographics.
  • Periodic follow up with Mount Sinai Medical Affairs team and the CBO Credentialing team to confirm status of enrollments. Build & maintain meaningful relationships with plan representatives.
  • Maintain clear and concise records of all enrollment submissions. Share Provider Insurance Participation lists for relevant departments upon receipt of official PAR status notifications from the CBO and Delegated Credentialing teams.
  • Trouble shoot, critical thinking, prioritize work flow.
  • Comply with requests made by insurance carriers, provider representatives and physicians daily.
  • Assists with Managed Care audits, work closely with Practice Administration on file selection and adherence to governing body guidelines/standards.

• About the company

  The mission of the Mount Sinai Health System is to provide compassionate patient care with seamless coordination and to advance medicine through unrivaled education, research, and outreach in the many diverse communities we serve.

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