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Payer Enrollment Specialist

Company: Toledo Clinic Inc
Location: Toledo
Posted on: September 23, 2022

Job Description:

General Summary: Responsible for assisting the Credentialing Specialist(s) in all aspects of physician and physician extender credentialing. This includes but is not limited to 3rd party health plan enrollment, hospital privileges, new recruit processing, preparation of malpractice applications.

Principal Duties & Responsibilities:

1. Primary responsibilities include taking a new provider application from receipt to inclusion in directory and making ongoing updates

2. Accurate and timely entry of provider data, including provider applications and contract information, status changes, payee changes

3. Maintains credentialing data base and hard copy file with current credentialing information for all physicians.

4. Gathers and completes all provider applications as required by insurance carriers.

5. Performs primary verification of pertinent data as necessary.

6. Makes inquiries to AMA, National Practitioner Data Bank and malpractice carrier.

7. Follows up with insurance carriers/hospitals, etc. to monitor status of applications.

8. Prepares hospital privilege applications and all insurance credentialing forms for new physicians.

9. Maintains Excel database to track physician participation status with insurance carriers.

10. Coordinates re-appointment of Toledo Clinic physicians to TCI medical staff.

11. Monitors renewal status of physician licensure, DEA and Board certification status

12. Researches privileges and insurance coverage rights for new positions to the clinic (ie.: Nurse Practitioner).

13. Seeks appropriate tasks when primary tasks are completed and assists coworkers as needed

14. Assists Credentialing Specialist with other duties as assigned

Knowledge, Skills & Abilities:


* 1-2 years of experience in a business environment
* Knowledge of Microsoft Access, Word, and Excel necessary
* Organized, analytical, detail and deadline-driven
* Knowledge of area insurance health plans and familiarity with primary source verification
* Familiarity with medical terminology for processing delineation of privilege documents
* Professional attire and timeliness
* Adheres to Clinic's policies and procedures


* Medical staff credentialing experience including software data base processing
* Data entry and maintenance of credentialing software and processing

Keywords: Toledo Clinic Inc, Toledo , Payer Enrollment Specialist, Other , Toledo, Ohio

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