ABOUT SHERIDAN MEMORIAL HOSPITAL

 

Sheridan Memorial Hospital, ranked in the top 13.6% of hospitals by CMS, delivers outstanding patient-centered care through a dedicated team of over 850 employees and 100+ expert providers across 25 specialties. Located in the stunning Big Horn Mountains, Sheridan combines outdoor adventure with community spirit. Our advanced technology and collaborative environment foster creativity and innovation. Join a team that values your skills, supports your growth, and empowers you to make a difference. Be part of something exceptional—apply today and help us continue our mission of excellence at Sheridan Memorial Hospital!

 

JOB SUMMARY

 

This position assists with enrolling all providers and facilities affiliated with Sheridan Memorial Hospital/Clinic system with commercial and/or government payers and various health plans through all stages of the application and reapplication within the system wide practitioner enrollment database. This job primarily uses remote and electronic means (ie computer, phone, fax) to accomplish tasks and required a high level of detail, efficiency, and time with online software programs.

 

Essential Job Functions

 

• Submit and maintain individual provider initial and re-credentialing enrollments with over 20 external payers and health plans to establish current and continuous enrollment of over 100 providers within the Sheridan Memorial Hospital / Sheridan Memorial Clinic system. 




• Assists PE Specialist 2 with facility initial and re-credentialing enrollments to include Hospital, Swing Bed, Home Care & Hospice and other affiliated SMH Clinics/Facilities.  




• Submits required enrollments to government payers on all providers and facilities in a manner commensurate with their expectations, policies and accreditation standards.




• Responsible for establishing standard work in entering, updating and ensuring practitioner information is current and accurate in both the internal software and with external payers.




• Works closely with the medical staff office in maintaining copies of licensure, certificates, and other documents necessary for the enrollment process.




• Facilitates and maintains each provider’s Council for Affordable Quality Healthcare (CAQH) and National Provider Identifier (NPI) online accounts. 




• Conducts verification of all data, ensuring accuracy and timely entry of information based on health plan deadlines and revalidation expirations.




• Consistently communicates essential updates with providers, payers, medical staff office, revenue cycle office via email, phone and mail through reporting methods.




• Performs initial and re-enrollment applications and revalidation tracking. Follows-up to ensure providers are linked to appropriate health plans in a timely manner and communicated in order to release pending claims. 




• Adheres to deadlines and enrollment schedules by tracking files through all stages




• Submits changes to practitioner information to delegated payers. Changes in information are also submitted to payers that require paper applications (this process is similar to the initial enrollment process).




• Identify, analyze and resolve extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to enroll practitioners and ultimately bill and obtain reimbursement for services rendered




• Discovers and convey problems to billing team and Manager so that the optimal course of action is taken by making sound decisions.




• Coordinates with third party enrollment agencies, as contracted with, who assist with provider enrollment needs.




• Maintains confidentiality and responsibility for all enrollment files through the process.




• Serves as backup to Provider Enrollment Specialist 2, familiar with additional enrollment duties. 





 

 

POSITION QUALIFICATIONS

 

Education, Experience & License

 

• High School Diploma or GED; Associated degree or above




• 0-5 years, preferred provider enrollment/billing/payer insurance experience & knowledge; database experience, preferred




• Prior healthcare industry experience, preferred




• NAMSS membership, eligible and plan to attain





 

 

Additional Skills

 

• Excellent organizational skills and attention to detail with high degree of accuracy.




• Must be able to multi-task and adhere to strict deadlines. 




• Strong computer and typing skills.




• Strong communication skills as you will be speaking with payers, facilities, medical billing staff and/or




• clients on a daily basis utilizing phone/email. 




• Self-driven and use critical thinking skills to develop efficient, streamlined processes.




• Preferred experience with credentialing, external databases, and billing operations. 




• Troubleshoots issues in a professional manner to all stakeholders.




• Is flexible to frequent change in duties, expectations and deadlines. 




• Database management skills including querying, reporting, and document generation.




• Demonstrated ability to use PC’s, Microsoft Office suite (Including: Word, Excel and Outlook, CAQH), and general office equipment (i.e. printers, copy machine, fax machine, etc.) required.




• Demonstrated human relation and effective communication skills.




• Attention to detail with high degree of accuracy.




• Demonstrates an independent work initiative, sound judgement and strong work ethic.




• Ability to adhere to strict deadlines.




• Demonstrate strong interpersonal skills and excellent written and verbal communication skills.





 

 

 

 

Specific demands not listed: Possible exposure to blood and or body fluids / infectious disease / hazardous waste requiring the use of Personal Protective Equipment. Exposure to odorous chemicals / specimens and Latex products.

Pre-employment drug and alcohol screening is required.

 

Sheridan Memorial Hospital is an equal opportunity/Affirmative Action employer and gives consideration for employment to qualified applicants without regard to race, color, religion, age, sex, national origin, disability or protected veteran status.  If you would like more information about your EEO rights as an applicant under the law, please click here.