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Enrollment Services Coordinator


At Lancaster General Health, our culture is what sets us apart and creates a lasting impression of our health system in the community and in the hearts of our patients and their families. A role with us is more than just a job, we ask that you Live Your Legacy at LGH by finding your passion in your everyday role, committing to those you serve, and reaching for your personal best.

We are recognized as 1 of only 9 hospitals in the entire country with awards in Medicare.Gov, LEAPFROG and Healthgrades Americas 50 Best Hospitals. We have attained four-year Magnet ® recognition status for the fourth time with the American Nurses’ Credentialing Center (ANCC) and we are the 2018 recipient of the Foster G. McGaw Prize in recognition of the commitment to community service.

PENN MEDICINE LANCASTER GENERAL HEALTH offers a comprehensive benefits package:

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program so that our employees can stay actively engaged and committed to living their legacy every day. Together, we will continue to make medical advances that help people live longer, healthier lives.

Join us and be part of a team that empowers you to do more than your job and encourages you to:

Live Your Passion. Live Your Best. Live Your Commitment. Live Your Legacy.

Company

Lancaster General Medical Grp

Cost Center

61024 Payor Enrollment Services

Supervisory Organization

Patient Financial Services- Leadership

Grade

G08

Benefits of Joining Penn Medicine Lancaster General Health:

PENN MEDICINE LANCASTER GENERAL HEALTH combines a Nationally Ranked Hospital with great schools, safe neighborhoods, affordable housing, local community events and festivals as well as a wealth of cultural and recreational activities. The scenic Susquehanna River Valley provides opportunities for fishing, skiing, kayaking, hiking and mountain biking in addition to easy access to NJ shoreline or Delaware beaches. Urban life is easily accessible, with New York, Baltimore, Philadelphia and Washington D.C. a train ride away. Local universities, Fulton Theatre, the downtown shopping and dining district and local sports teams make Lancaster a great place to Live, Work and Play.

Summary

POSITION SUMMARY:  Individual will be a part of a team responsible for enrolling approximately 2900+ Health Care Providers with various health plans to ensure UPHS’ ability to bill and receive reimbursement for services rendered. Individual will be responsible for initiating the enrollment process and tracking it to completion with the assigned health plan(s).

ESSENTIAL FUNCTIONS: Qualified individuals must have the ability (with or without reasonable accommodation) to perform the following duties:  

  • Works with providers, department, and Professional Billing Office to complete provider enrollment process in a timely and efficient manner in accordance with service standards.
  • Works with payor staff to ensure their information needs are met and that they provide provider numbers on a timely basis
  • Proofs provider directories as needed and requested by payors.
  • Sets up physician/auxiliary provider files.
  • Prepares for and conducts new provider interviews as assigned by manager.
  • Completes, sends and follows up with managed care profiles and indemnity applications for assigned plans.
  • Processes changes requested by departments/practices via Change Form or other appropriate means.
  • Performs special projects and/or runs reports to support the provider enrollment process
  • Serves as liaison between the departments/practices and health plans in order to resolve questions and issues.
  • Updates internal aging reports for assigned plans.
  • Issues external aging report for all assigned plans.
  • Maintains proficiency in utilization of enrollment databases.
  • Sets up enrollment database with new providers linking them to the appropriate plans and practice locations.
  • Maintains the auxiliary provider database.
  • Analyzes the weekly PBO edit report for assigned plans.  Obtain and provide missing information to PBO in order for claims to clear the enrollment edits.
  • Researches department/practice complaints and/or independently identifies data errors/inconsistencies and other problem areas with enrollment database and resolves or refers issues to manager as appropriate.

SECONDARY FUNCTIONS: The following duties are considered secondary to the primary duties listed above:  

  • Assists with phone coverage as needed.
  • Other duties as assigned.

JOB REQUIREMENTS

MINIMUM REQUIRED QUALIFICATIONS:  

  • High school diploma or GED required.
  • At least one year of experience working in a managed care setting or a related field required.
  • Must have working knowledge, understand, and comply with the enrollment process of varied Managed Care Plans, Medicare, and Medicaid programs.
  • Proficient in computers and computer software including, but not limited to, database management, spreadsheet and word processing applications. 
  • Ability to maintain confidentiality with regard to information
  • Must be organized and detail oriented.
  • Must be able to work independently and take initiative to research and resolved enrollment related issues.
  • Communication in a professional manner is a must with health plans, practice managers, billing staff, physicians, and team members.  

PREFERRED QUALIFICATIONS: 

COGNITIVE REQUIREMENTS

Attention/Concentration: The following level of ability is essential for the jobholder to focus on certain aspects of current experience and reject others.  

  • The position requires strong concentration skills.  The individual must have the ability to voluntarily sustain concentration to a task over an extended period of time as a result of an effortful and usually deliberate heightened and focused state of attention.

New Learning and Memory: The following level of ability is essential for the jobholder to learn and retain material.  

  • The position requires that an individual be able to learn new tasks quickly and effectively.  Job requirements change frequently.  The ability to understand and carry out detailed, involved instructions is mandatory.

Problem Solving, Reasoning and Creative Thinking: The following level of ability that is essential for the jobholder to think (in order to solve a problem) by combining two or more elements from past experience or imaginative thought.  

  • The position deals with issues or problems that often require thoughtful reasoning before arriving at approaches or solutions.  Some independent thought, planning or origination of options and solutions is necessary.  The individual must have the ability to apply principles of reasoning and problem solving to resolve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists.

APTITUDES:  The following are essential requirements of the position in relation to job-worker situations.  These items describe how a worker must adapt, adjust, conform or act.  

Performing under stressful conditions: Ability to perform under stress when confronted with emergency, critical, unusual, or dangerous situations, or in situations in which working speed and sustained attention are critical aspects of the job. Is subject to danger or risk, or to tension as a regular, consistent part of the job.

Variety and change: Ability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure involving significant differences in technologies, techniques, procedures, environmental factors, physical demands, or work situations.

Communication:  Ability to exchange information with others clearly and concisely; to present ideas, facts and technical information.

Interpersonal relations: Ability to maintain relationships that facilitate task accomplishment; to cooperate and resolve conflicts; to recognize needs and be sensitive of others.

EQUIPMENT USAGE REQUIREMENTS

Equipment/Tools: Computer, Phone, Copier, Printer, Fax, Office Supplies  

Software: Microsoft Office Products  

PHYSICAL REQUIREMENTS

Rarely 0-10%; Occasionally 11-35%; Frequently 36-70%; Continuously 71-100%

Body Position/Movement:  

  • Sit: Frequently
  • Stand: Frequently
  • Walk: Frequently
  • Bend: Occasionally
  • Push: Rarely
  • Pull: Rarely
  • Kneel/Squat: Rarely
  • Reach: Rarely
  • Twist: Rarely
  • Balance: Rarely
  • Climb: Rarely

Lifting: Degree of physical exertion is:  Light, exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to move objects.

Sensory Abilities specifically required:

  • Vision
  • Hearing

PHYSICAL ENVIRONMENT

WORKING CONDITIONS:  Exposure to hazardous conditions/ materials is negligible.

                       

Disclaimer: This job description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job.  It is intended to be a reflection of those principal job elements essential for recruitment and selection, for making fair job evaluations, and for establishing performance standards.  The percentages of time spent performing job duties are estimates, and should not be considered absolute.  The incumbent shall perform all other functions and/or be cross-trained as shall be determined at the sole discretion of management, who has the right to amend, modify, or terminate this job in part or in whole.  Incumbent must be able to perform all job functions safely.

Disclaimer

PENN MEDICINE LANCASTER GENERAL HEALTH is an Equal Opportunity Employer, committed to hiring a diverse workforce. All openings will be filled based on qualifications without regard to race, color, sex, sexual orientation, gender identity, national origin, marital status, veteran status, disability, age, religion or any other classification protected by law.

 

Search Firm Representatives please read carefully: PENN MEDICINE LANCASTER GENERAL HEALTH is not seeking assistance or accepting unsolicited resumes from search firms for this employment opportunity. Regardless of past practice, all resumes submitted by search firms to any employee at PENN MEDICINE LANCASTER GENERAL HEALTH via-email, the Internet or directly to hiring managers at Penn Medicine Lancaster General Health in any form without a valid written search agreement in place for that position will be deemed the sole property of PENN MEDICINE LANCASTER GENERAL HEALTH, and no fee will be paid in the event the candidate is hired by PENN MEDICINE LANCASTER GENERAL HEALTH as a result of the referral or through other means.

BURLE Full Time Posted on 01/06/2021