Job Description
Prepare, submit, and scan approximately 1,000 provider enrollment applications per year for Medicare, Medicaid, Blue Cross, Blue Shield, CAQH and other payer programs as needed and is responsible for all aspects of payer portal access for individual providers. Submit all applications to supervisor/manager for audit, working towards an error rate of less than 10%. Monitor submitted provider enrollment applications to ensure approvals are received and communicated to billing team prior to timely filing, working towards the team’s overall goal of not having pending applications over 6 months after the start date. Approvals are received and communicated to billing team prior to timely filing, working towards the team’s overall goal of not having pending applications over 6 months after the start date. Manage daily administrative duties with an emphasis on enhancing efficient workflows. Prioritize requests, manage time, and workload to execute project plans within given deadlines. Comfortable with working remotely full-time. Ability to work independently with little guidance and adapt. Respond to internal and external inquiries on routine enrollment and contract matters, including follow-up with payers on applications as frequently as every 2 weeks. Serve as liaison between billing company, providers, and payer representatives to resolve all provider enrollment issues with assistance from supervisor/manager. Coordinate credentialing process with assistance of an on-site administrator as needed to complete credentialing for initial, updating, and add-on applications and maintenance processes. Communicate with providers and other departments to update as needed, clarify carrier information requirements, and maintain a strict level of confidentiality for all matters pertaining to provider credentials. Salesforce configuration changes including but not limited to record types, dashboards, reports, and custom settings. Update records in Salesforce with billing numbers, contract information, submission dates of applications, and notation of any communications or problems that require attention. Record extensive documentation in databases for any ongoing or open tasks. Ability to use Salesforce data loader for bulk import of data to individual enrollment contracts. Deactivate inactive providers from Medicare, Medicaid, and other payers to remain compliant with federal and state regulations. Ensure data integrity and participate in trainings and development to mitigate compliance risk with state and federal regulations. Work with multiple departments to review proforma for new contracts and assist to protect revenue. Learn to research numerous payer issues and work to resolve with payers and billing company quickly and effectively with oversight from supervisor/manager with overall goal to lose less than $100K in revenue per year. Contribute and assist with implementation of process improvement ideas by participating in payer trainings and webinars as needed. Support research, review, and testing of educational materials for organization growth. HS Diploma in combination with relative work experience required. 2-4 years related healthcare experience required. Bachelor’s degree is preferred. 3+ years of related healthcare experience preferred. Knowledge of billing or reimbursement is desired. Provider Enrollment experience is desired. Ability to effectively interact with providers, payer representatives, internal departments, team members, and other stakeholders, both in written and verbal communication. Ability to accomplish tasks thoroughly and accurately. Ability to effectively manage time and organize. Ability to learn billing processes, including timely filing and claims denial reasons. Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, OneDrive, PowerPoint, etc.). Knowledge of additional technology-based assistance (Teams, SharePoint, etc.). Knowledge of online Medicare/Medicaid enrollment systems, Identity & Access system, Counsel for Affordable Quality Healthcare system, Medicare enrollment specialties, and National Provider Identifier taxonomies. Develop critical thinking skills and professional relationships. Trainings to help support and advance your professional growth. Dental, Vision, HSA/FSA, Life and AD&D coverage, and more. EAP, travel assistance, and identify theft included. Required Experience and Competencies.