Provider Enrollment Specialist Jobs

Overview:

Job Summary:

• The Provider Enrollment Specialist works in conjunction with the Provider Enrollment Manager to identify Provider Payer Enrollment issues or denials. This position is responsible for researching, resolving, and enrolling any payer issues, utilizing a variety of proprietary and external tools. This may require contacting clients, operations personnel, and Centers for Medicare & Medicaid Services (CMS) via phone, email, or website.

Responsibilities:

Essential Functions and Tasks:

• Maintains documentation and reporting regarding payer enrollments in process.
• Performs tracking and follow-up to ensure provider numbers are established and linked to the appropriate client group entity and proper software systems
• Maintains provider demographics in all applicable enrollment systems
• Performs special projects and other duties as assigned
• Proactively obtains, tracks, and manages all payer revalidation dates for all assigned groups/providers as well as complete, submit, and track the required applications to maintain active enrollment and prevent deactivation
• Retains records related to completed CMS applications
• Performs follow-up with Centers for Medicare & Medicaid Services (CMS), and other payer via phone, email or website to resolve any Payer Enrollment issues
• Establishes close working relationships with Clients, Operations, and Revenue Cycle Management team
• Manages the completion and submission of CMS Medicare, State Medicaid and any other third-party payer applications
• Adds providers to all applicable systems and maintains information to ensure claims are held/released based on status of enrollment
• Performs follow-up with market locations to research and resolve payer enrollment issues

Qualifications:

Education and Experience Requirements:

• Bachelor’s Degree in Healthcare Administration, Business Administration, Benefits, or equivalent training and/or experience preferred
• At least one (1) year of provider enrollment experience preferred
• High School diploma or equivalent

Knowledge, Skills, and Abilities:

• Strong word processing, spreadsheet, database, and presentation software skills
• Strong decision-making skills
• Strong oral, written, and interpersonal communication skills
• Ability to take initiative and effectively troubleshoot while focusing on innovative solutions
• Ability to maintain strict confidentiality with regards to protected provider and health information
• Ability to work cohesively in a team-oriented environment
• Strong time management skills
• Ability to ensure the complex enrollment packages are complete and correct
• Strong analytical skills
• Strong problem-solving skills
• Working knowledge of physician HIPAA Privacy & Security policies and procedures
• Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately
• Ability to remain flexible and work within a collaborative and fast paced environment
• Ability to work independently and require little supervision, to focus on and accomplish tasks
• Strong mathematical skills in addition, subtraction, multiplication and division of whole numbers and fractions; and working with decimals
• Ability to communicate with diverse personalities in a tactful, mature, and professional manner
• Ability to foster good working relationships with others both within and outside the organization
• Strong detail orientation skills
• Strong organizational skills
• Working knowledge of specific application requirements for Centers for Medicare & Medicaid Services (CMS), State Medicaid and all third-party payers including pre-requisites, forms required, form completion requirements, supporting documentation such as Drug Enforcement Agency Number (DEA), Curriculum Vitae (CV), and regulations.

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