Responsible for the coordination of D-HH provider enrollment, Epic SER access, and insurance related claims management.

1. Serves as liaison between D-HH credentialing, D-H contracting, Conifer RMD, external payors and facilities.
2. Enrolls providers for network participation with Governmental and contracted Commercial/ Managed Medicaid health plans.
3. Assists in the development and maintenance of the credentialing database. Enters new data and updates existing enrollment records.
4. Reviews claim work queues, conducts necessary research, and works with the appropriate parties to correct edits or address denials.
5. Manages the resolution of enrollment issues relating to timely and accurate reimbursement of services.
6. Generates NCQA/ delegated credentialing provider exclusion queries.
7. Submits provider demographics for initial Epic EMR access and terminates inactive provider records.
8. Maintain aspects of the Epic provider SER records, including but not limited to; demographics, billing, admitting, departments/revenue routing.
9. Maintains electronic prescribing rights (EPCS) and state license data.
10. Maintains, tracks, and enters enrollment confirmations into the credentialing database and Epic, controlling claims submission.
11. Coordinates, schedules and participates in managed care audits. Reviews files prior to audit.
12. Assists with updates and changes that effect how services are billed.
13. Reports on missing provider information.
14. Audits data to ensure accuracy for reporting to payers.
15. Responds to DHSM tickets regarding provider access issues.
16. Performs other duties as required or assigned.

• High School diploma or the equivalent required.



• Minimum of two years healthcare experience required.



• Strong written and verbal interpersonal skills required.



• Must be detail oriented.



• Experience with CAQH is preferred.



• Experience with Epic is preferred.



• Demonstrated proficiency in word processing, spreadsheet software, database management and data entry preferred.

• None