At Children’s Wisconsin, we believe kids deserve the best.

Children’s Wisconsin is a nationally recognized health system dedicated solely to the health and well-being of children. We provide primary care, specialty care, urgent care, emergency care, community health services, foster and adoption services, child and family counseling, child advocacy services and family resource centers. Our reputation draws patients and families from around the country.

We offer a wide variety of rewarding career opportunities and are seeking individuals dedicated to helping us achieve our vision of the healthiest kids in the country. If you want to work for an organization that makes a difference for children and families, and encourages you to be at your best every day, please apply today.

Please follow this link for a closer look at what it’s like to work at Children’s Wisconsin: https://www.instagram.com/lifeatcw/

Children's Wisconsin is hiring an experienced Provider Data Enrollment Coordinator to manage the enrollment for our employed providers with various insurance and managed care entities. The ideal candidate has five or more years of relevant experience and strong organizational skills

Work Schedule: Full -Time, Remote

What you will do:

This position will coordinate and perform the CHHS employed provider enrollment processes for various entities including, Children's Medical Staff, contracted managed care plans, insurance companies, PPO networks, employer direct contracts, and government payers. It involves accurate data entry and completion of all required information for the CHHS employed providers, including guiding them through the various processes. Communication with internal and external customers will ensure the required process is completed timely and accurately. The Coordinator will utilize a variety of proprietary and external tools, including Microsoft Excel and Word.

Essential Functions:

• Coordinates the specific application requirements for each entity that provider will need to be enrolled.

• Obtains and assembles necessary information and documents for the provider enrollment .

• Performs audits of the provider files to ensure data integrity of required information prior to processing applications.

• Problem-solves with providers to obtain missing data or documents required for the various applications and enrollment forms.

• Enters all provider information onto the initial and on-going payer enrollment and credentialing applications in accordance with the CHHS process guidelines. This will include the hospital privileging applications and reappointments to hospital entities.

• Coordinates the completion of initial applications for malpractice insurance for all CHHS employed providers and manages the distribution of all certificates annually.

• Enters the provider data into the database tool to ensure current information is captured for the entities that require electronic submission of provider information for enrollment. Coordinates ongoing audits of the database for accuracy of all provider data entered.

• Develops and maintains electronic copies of all completed enrollment and credentialing provider data files in an organized and timely manner.

• Maintains the participation matrix by provider and facility that is used to track participation of the provider or facility in the various contracted networks and contracts.

• Manages ongoing expireables process for all providers and assures that updated information is obtained, stored, and provided as applicable within the expected timeframe.

• Continually improves and develops processes and/or systems to gain efficiencies that affect the payer enrollment and credentialing process of CHHS employed providers.

• Organizes credentialing and physician files for Senior Credentialing Coordinator for audits by regulatory authorities.

• Provides support as needed to the Payer Contracting and Revenue Cycle teams to investigate issues and resolve problems related to provider participation status, claim submission and payment.

• Drafts and distributes notices of additions, changes, and terminations of provider information.

• Verifies the ongoing accuracy of on-line and paper provider directories.

What you will need:

• Associates Degree preferred. Minimum of five years of Payer credentialing, managed care, health insurance, or health system experience required.

• Ability to type 30+ words per minute preferred.

• Proficient with Microsoft Office, including Outlook email with an emphasis on Excel and Word required.

• Maintains a high degree of confidentiality in dealing with sensitive provider issues and data.

• Strong customer service and interpersonal skills to work well with internal (physicians, etc.) and external customers (insurance companies, etc.)

• Strong organizational skills with the ability to prioritize and meet deadlines.

• Must be detail-oriented in order to ensure all required information/data has been received and processed to meet credentialing timelines.

• Must be able to work cohesively in a team oriented environment and able to foster good working relationships with others both with internal and external customers.

Children's Wisconsin is an equal opportunity / affirmative action employer. We are committed to creating a diverse and inclusive environment for all employees. We treat everyone with dignity, respect, and fairness. We do not discriminate against any person on the basis of race, color, religion, sex, gender, gender identity and/or expression, sexual orientation, national origin, age, disability, veteran status, or any other status or condition protected by the law.

Certifications/Licenses: