Provider Enrollment Specialist II - Health Plan Enrollment

Summary:

Coordinates Medicare and Medicaid enrollment/re-enrollment and managed care credentialing and contracting processes for providers. Serves as administrator for billing system and assists practices with system issues. Maintains NPI files and provider numbers. Serves as customer service liaison. Monitors accounts receivable to maintain appropriate levels and reviews payments to maximize reimbursement. Interacts with patients, insurance carriers, the billing vendor and practice personnel concerning patient accounts. Performs all functions in a courteous and professional manner.

Responsibilities:

• Collects and maintains data on providers for Medicare and Medicaid enrollment
• Prepares and submits applications to Medicare and Medicaid for new provider enrollments and existing provider updates; follows up by telephone or in writing, with carriers regarding application status
• Complies with Medicare and Medicaid provider enrollment guidelines
• Requests NPI numbers for providers and clinics as necessary and maintains NPI files
• Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and/or appeals
• Generates various reports to identify outstanding claims issues with provider numbers and non-payment
• Communicates information to appropriate personnel
• Educates staff on corrections, e.g.. front-end entry errors in a positive, constructive manner
• Collects and reviews managed care contracts for correct billing and payment terms
• Identifies problem accounts and follows through to completion
• Reviews Athena correspondence and unpostables
• Participates in company sponsored enrollment/credentialing meetings and other educational activities
• Participates in Billing System Training exercises and updates
• Assists in training on the Billing System software package when necessary
• Serves as a Superuser of the Billing System to be available to answer questions from the various clinics
• Follows the CHRISTUS guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
• Maintains strict confidentiality
• Uses oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with the CHRISTUS Mission
• Maintains established CHRISTUS policies, procedures, objectives, quality assurance, safety, environmental and infection control
• Implements job responsibilities in a manner that is consistent with the CHRISTUS Mission and Code of Ethics and supportive of CHRISTUS Physician Group’s cultural diversity objectives
• Performs other related work as required

Requirements:

• High School Diploma
• 1-3 years of Payer Enrollment experience
• Solid knowledge and utilization of PC applications to include WORD, EXCEL, ACCESS
• Excellent written and verbal communication skills
• Excellent organization and planning skills with demonstrated teamwork skills
• Proven ability to interact with all levels of management and other Associates

Work Type:

Full Time

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