Sea Mar Community Health Centers, a Federally Qualified Health Center (FQHC) founded in 1978, is a community-based organization committed to providing quality, comprehensive health, human, housing, educational and cultural services to diverse communities, specializing in service to Latinos in Washington State. Sea Mar proudly serves all persons without regard to race, ethnicity, immigration status, gender, or sexual orientation, and regardless of ability to pay for services. Sea Mar's network of services includes more than 90 medical, dental, and behavioral health clinics and a wide variety of nutritional, social, and educational services.
Sea Mar seeks an experienced provider enrollment specialist in Seattle, WA. The provider enrollment specialist is responsible for ensuring accurate and timely processing of site and provider enrollments for all Medicare, Medicaid, third party insurances, and private pay programs, including special programs. The Provider Enrollment Specialist is a solution-driven professional who provides exceptional customer service to internal colleagues and external partners.
Primary duties and responsibilities are:
Submitting Medicare and Medicaid provider and site enrollments and revalidations.
Enrolling new providers and re-credentialing all providers and sites in all health plans to ensure timely billing, including gathering information and supporting documentation, and submitting. Includes updating and maintaining rosters for health plans to avoid billing disruptions.
Maintaining master roster of providers and sites, including updating information necessary for enrollments and status of effective dates for various insurances.
Corresponding with insurance plans to verify information is received and records are current, and troubleshooting if needed.
Informing the Administration Director of any concerns or issues preventing insurance plans from updating records or enrolling providers.
Maintaining credentialing profiles and archiving documentation for all enrollments.
Utilizing SharePoint for enrollment status reports and roster information.
Maintaining databases including, but not limited to, Provider Source, CAQH, Identity and Access System, PECOS.
Adding personnel to patient management (PM) system.
Implementing and maintaining delegated credentialing.
Maintaining knowledge of CMS, The Joint Commission, NCQA, URAC and HRSA credentialing requirements, as well as processes and requirements for insurance plan provider enrollment.
Serving as organizational point person for any billing issues related to credentialing.
Other duties as assigned.
The successful candidate will have the following qualifications:
Intermediate computer skills including Microsoft products, especially Microsoft Excel and web-based inquiries/databases preferred.
Demonstrated ability to manage multiple priorities and competing deadlines at the same time.
Demonstrated problem-solving skills.
Working knowledge of The Joint Commission, NCQA, and CMS credentialing and privileging standards.
Experience with provider and health plan credentialing.
Experience with credentialing software is desirable, MD Staff preferred.
Ability to add, subtract, multiply and divide in all units of measure including whole numbers, common fractions and decimals required.
Ability to compile, interpret and utilize information.
Ability to work well with a diverse group of individuals including staff and clients.
Ability to resolve issues in a timely manner.
Ability to communicate detailed information and processes in a clear, concise manner, both verbally and in writing.
Must be detail-oriented with demonstrated ability to follow processes and instructions in order to complete enrollment applications and insurance plan provider credentialing requirements.
College degree preferred, high school diploma acceptable if previous work experience in managed care, hospital or medical office environment.
Experience with provider enrollment and delegated health plan credentialing agreements preferred.
Ability to speak and read English required; bilingual English/Spanish preferred.
Additional Salary Information: We offer an excellent compensation package, which includes Medical, Dental and Vision coverage, generous PTO/Holidays, and 401(k)/Retirement options and an opportunity to work in a culturally diverse environment. Sea Mar is an Equal Opportunity Employer.
Sea Mar Community Health Centers is a community-based organization committed to providing quality, comprehensive health, human, housing, educational and cultural services to diverse communities, specializing in service to Latinos.
Sea Mar Community Health Centers is committed to:
Providing customer-driven services with respect and sensitivity to persons of all cultural and socio-ec...onomic backgrounds.
A partnership among customers, Board, staff and communities to provide affordable and accessible quality services.
Providing continuity of care through an interdisciplinary approach that meets the needs of our communities.
Educating clients to promote healthy lifestyles and disease prevention.
Maintaining a diverse workforce in a professional environment that promotes employee satisfaction and well-being.
Providing educational and professional growth opportunities in the multilingual/multicultural delivery of health and social services.
Providing leadership and advocacy to empower our communities.
Operating in well-maintained, attractive facilities with high-quality equipment.
Remaining an independent, fiscally sound non-profit organization.
Sea Mar Community Health Centers is as an innovative, national leader in health and social services by delivering high quality, integrated care for underserved communities. Sea Mar endorses and promotes The Triple Aim of taking care of the health needs of the patient, improving the health of the population and at the lowest possible cost. Sea Mar will accomplish The Triple Aim by becoming an Accountable Care Organization (ACO) or partnering with other ACOs throughout its service area. Sea Mar will continue to look beyond healthcare to the social determinants of health and will focus on the contributing factors that allow members of the community to lead healthy, fulfilling lives. Sea Mar will accomplish this by expanding services to respond to community need, including specialty services, housing, education and other services. Sea Mar places top priority on advocacy, and will continue to be a strong voice for the communities it serves, working at the local and national levels to demand social justice for all.