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.
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.