Facility Enrollment Coordinator - Revenue Cycle Operations

Essential Job Statements

• Complete and submit initial and ensuing facility credentialing applications in accordance with payer policies, legal requirements, and regulatory standards

• Collect and compile from multiple facilities and sources the most current versions of data and documents required for credentialing, such as from VDH, DEA, CLIA, JCAHO, liability certificates, Board of Director listings, and other documents

• Perform ongoing validation of application information, data and documents ensuring facility enrollment accurately reflects health system for purpose of both network participation and reimbursement

• Represent VCU Health System Authority when attesting to accuracy of application, data and document submissions understanding false representation may result in penalties, fines, or imprisonment

• Track application, data and document submissions submissions until enrollment achieved ensuring no interruption in enrollment status

• Organize and maintain historical account of application, data and document submissions ensuring readiness for compliance with payer, state, and federal audits Maintain matrix identifying last and upcoming credentialing renewal dates including but not limited to state licensure, DEA, CLIA, JCAHO, etc., ensuring most recent document versions are available when requested

• Maintain matrix identifying last and upcoming credentialing renewal dates including but not limited to state licensure, DEA, CLIA, JCAHO, etc., ensuring most recent document versions are available when requested.

• Maintain facility and location identification numbers and effective dates as assigned by payers and/or government agencies as needed for facility credentialing.

• Obtain and maintain access to payer and agency websites and portals

• Utilize considerable latitude, judgment, and independent decision-making in response to situations and people, assessing the relative importance of issues and prioritizing response based on those judgments

• Follow up with payers and agencies ensuring credentialing application is processed with all data and documents needed until active participating status is achieved.

• Enter submitted application, data and document information into credentialing database and status notes for documentation purposes.

• Work with payer representatives to resolve facility credentialing issues causing billing delays or payment denials, or any other issues causing barriers to patient care.

• Continually assess payer denials and edits for impact of facility credentialing on revenue performance.

• Prepare monthly, quarterly, and ad hoc reports as needed to communicate facility enrollment requirements and performance.

• Maintain expert knowledge of facility credentialing policies and requirements with understanding that each payer and agency may require compliance with different policies, regulations, and standards.

• Maintain expert knowledge of complex requirements related to CMS Provider Based Billing and the impact that facility credentialing, and enrollment have on hospital billing and reimbursement.

• Support development of proformas for new and expanded facilities through extraction, analysis, and modeling of provider-based billing reimbursement for purposes of advising hospital management on financial feasibility.

• Provide training and education to staff and leader about facility credentialing/enrollment and provider-based billing, including participation in meetings to explain payer policies, legal requirements, and regulatory standards

• Coordinate and lead cross-department project teams to identify root cause, evaluate solutions, and implement improvements related to facility credentialing

• Communicate pertinent information to internal and external stakeholders in a manner that is most appropriate for the audience and purpose

• Participates in additional work as related to the job functions contained within this job description to enhance revenue opportunities.

Patient Population

Not applicable to this position.

Employment Qualifications

Required Education:

High School Diploma or GED

Preferred Education:

Bachelor's Degree

Licensure/Certification Required:

Licensure/Certification Preferred:

Minimum Qualifications

Years and Type of Required Experience

3 years of experience in healthcare billing, physician practice or credentialing environment.

Other Knowledge, Skills and Abilities Required:

• Proficiency in Microsoft Office Word, Excel, and PowerPoint applications

• Experience evaluating patient and financial transactions from multiple data sources including Epic, Workday, Strata, and Tableau

• Must be highly organized and detail oriented.

• Ability to communicate effectively verbally and in writing at all levels

• Ability to work concurrently on multiple projects and prioritize workload

• Ability to work effectively in complex and fast paced environment and comfort with accountability to multiple departments

• Strong relationship and collaboration skills to partner closely with internal and external partners

Cultural Responsiveness

Demonstrate a commitment to diversity, equity, and inclusion through continuous development, modeling inclusive behaviors, and proactively managing bias

Other Knowledge, Skills and Abilities Preferred:

Working Conditions

Periods of high stress and fluctuating workloads may occur.

Physical Requirements

Physical Demands: Lifting/ Carrying (0-50 lbs.)

Work Position: Sitting, Walking, Standing

Additional Physical Requirements/ Hazards

Physical Requirements: Repetitive arm/hand movements

Hazards:

Mental/Sensory -Emotional

Mental / Sensory: Reasoning, Problem Solving, Hearing, Speak Clearly, Write Legibly, Reading, Logical Thinking

Emotional: Fast pace environment, Able to Handle Multiple Priorities, Frequent and Intense Customer Interactions, Able to Adapt to Frequent Change

EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.