ESSENTIAL FUNCTIONS
Enrolls assigned facilities with government payers timely and accurate.
Follows Medicare PECOS Provider Enrollment Policy.
Follow Maryland Medicaid ePrep Enrollment Policy and other states as applicable
Ensures NPPES website and provider enrollment portal records are updated with providers’ most current billing-related information timely and accurate.
Applies for new NPI numbers as required.
Obtains and maintains information necessary for facility enrollments from A/R Managers, JH tax office, board secretary, board members, JH insurance office, etc.
Obtains and maintains copies of current facility & professional licenses necessary to update enrollments from point persons at JHCH
Completes revalidation enrollments as required and assures accurate hours of operation, product offerings, contact information, etc.
Coordinates updates with consideration of other changes needed or revalidation needed in near future.
Adds product offerings as necessary to enrollments and coordinates with the Quality Department to notify the accrediting body.
Resolve disputes, discrepancies, and other provider enrollment-related problems, as necessary.
Completes license applications as required and in a timely manner for assigned entities and works with LicenseLogix & licensing liaisons at JHCH to assure licensing is kept current.
Completes JHCH Managed Care payor credentialing documentation as required by each entity to remain contracted.
Completes network provider amendments, cover letters, and documentation tracking logs to support provider contracting changes.
Packages and coordinates certified mail and email communications to network providers, and managed care payers, upon contracting and/or policy changes.
Completes network provider credentialing, responds to network provider requests to join the network, and works with JHCH payor contracting liaison to ensure network adequacy.
Works with JHCH payor contracting liaison and Connections Financial Ops Program Manager to maintain relevant network provider contact lists via list serve to ensure providers receive accurate and timely notifications of network changes.
Will respond to credentialing application questions and/or assign to responsible part to complete within established guidelines.
Assemble the credentialing packet, complete data entry, and attach all required documentation to the application for circulation.
Circulate the credentialing packet to all JHHCBS stakeholders for review and obtain answers, resources, edits, and approval as needed
Updated (as necessary) and validated all application question sets, including a response and appropriate documents are attached.
Submit the completed credentialing package and memo to OSA Contracting.
Education:
Bachelor’s degree required
Demonstrated experience in provider enrollment with Medicare and/or Medicaid required
Equivalency allowed in place of education or experience
Work Experience: Minimum two (2) years of medical office and/or billing experience required.
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Diversity and Inclusion are Johns Hopkins Medicine Core Values. We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.
Johns Hopkins Health System and its affiliates are drug-free workplace employers.
Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.
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