Senior Enrollment Coordinator
Columbia University - New York, NY

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Reporting to the Enrollment Manager, the Sr. Enrollment Coordinator is responsible for timely and efficient enrollment of eligible providers in the ColumbiaDoctors network and respective delegated managed care plans. Develop and maintain relationships with Managed Care and Medicaid Managed Care Representatives and internal staff. Review and route all membership applications and affiliated documents according to PEG policies and procedures. Receives and reviews monthly payer rosters to ensure proper loading of ColumbiaDoctors demographic information based on data submitted.

Responsibilities include:
1. Responsible for review and submission of initial credentialing applications to the Credentials Verification Organization for primary source verifications.
2. Acts as a liaison between PEG and the Credentialing Committee Chair to review completed provider files prior to credentialing committee meetings. Notifies providers of discrepancies discovered through primary source verifications.
3. Prepares completed provider files for presentation and discussion at the credentialing committee by completing final review of credentialing requirements and determining appropriate level.
4. Responsible for timely notification of credentialing decisions to providers and departmental staff and designees. Updates credentialing database regarding credentialing decisions made by credentialing committee.
5. Responsible for management of the credentialing committee by coordinating monthly and ad-hoc meetings; preparation and distribution of committee meeting minutes.
6. Timely and accurate submission of monthly and ad hoc rosters to all Delegated Managed Care Organizations. Responsible for adhering to each plans requirements for roster submission.
7. Tracks the timely return of Delegated rosters from each Delegated MCO. Follows up with MCO's when rosters are not returned per contractual requirements. Escalates delinquency to manager, as needed.
8. Upon return of delegated rosters, verifies correct loading of physician demographic and tax identification information in payor system. Follows up with plan regarding incomplete rosters.
9. Responsible for the distribution of provider id and effective dates to PEG staff for accurate and timely updating of PEG databases. Distribute pertinent information to departmental staff/designee in a timely fashion.
10. Reviews and submits Medicaid Managed Care Delegated Spreadsheet Submissions to each plan. Upon return of each spreadsheet, distributes of provider id and effective dates to PEG staff for accurate and timely updating of PEG databases. Distribute pertinent information to departmental staff/designee in a timely fashion.
11. Acts as liaison with Medicaid Managed Care Payors and holds meetings on a regular basis to discuss enrollment and credentialing issues.
12. Facilitates straight Medicare and Medicaid enrollments on an as needed basis.
13. Responsible for Roster Reconciliations to ensure Managed Care Payors and PEG records accurately reflect participation status and valid demographics. Reviews provider participation rosters and compares information to PEG database. Follows up with payors for verification and completes reconciliations accordingly. Reviews and corrects provider demographic information.
14. Generates monthly enrollment, credentialing, and demographic reports for publication on the PEG Secure Server, distribution to internal and external representatives; provides additional reports to departments as requested.
15. Establishes and maintains positive relationships with physicians, administrators and Managed Care Payor representatives.
16. Assists with other special credentialing, enrollment and operational projects as needed.

Minimum Qualifications for Grade
Applicant MUST meet these minimum qualifications to be considered an applicant

Requires a bachelor's degree or equivalent in education and experience, plus three years of related experience.

Additional Position-Specific Minimum Qualifications
Applicant MUST meet these minimum qualifications to be considered an applicant

Specialized knowledge of Credentialing/Enrollment. One to three years experience in the use of relational databases and their supporting programs in Microsoft software. Working knowledge of Microsoft Word, Excel, Access or comparable word processing and spreadsheet software.

Customer service orientation a must. Time management and multi-tasking skills required. Communication skills, organizational skills, ability to prioritize and detailed oriented.

Preferred Qualifications

Special Instructions

Special Indications

This position works with:
There are no special indications for this position

HIPAA Compliance training required

Yes

Participation in Medical Surveillance required

No

What type of posting? Is this a waiver request?

Standard Posting

Requisition Open Date

04-23-2013

Requisition Close Date

Open Until Filled

Quick Link

jobs.columbia.edu/applicants/Central?quickFind=135675

Columbia University - 16 months ago - save job - block
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Founded in 1922 as one of the first three public health academies in the nation, Columbia University's Mailman School of Public Health...