PROVIDER ENROLLMENT SPECIALIST

Scope of Job

Coordinate, monitor and maintain the provider enrollment and re-enrollment processes in a timely and compliant manner with all government and commercial payors.

Description of Duties

• Facilitates all aspects of provider enrollment, including initial enrollment, re-enrollment, and monitoring of all providers to ensure proper and timely billing and collections.
• Prepares enrollment applications for all health plans including Medicare and Medicaid.
• Maintains timelines on enrollment processes and address and/or escalate any delays.
• Ensures that all pending enrollments are reviewed, obtained and managed according to the rules and policies of the department.
• Provides monthly notification of new providers, resignations and changes in provider status such as practice locations and panel status to contracted plans.
• Follows up with necessary contacts, including providers and managed care organizations, to resolve enrollment application issues and deficiencies.
• Assists with resolution of provider related denials to ensure appeal procedures are followed to result in proper reimbursement.
• Assists with problem identification and timely resolution of payor related issues.
• Responds to internal and external inquiries on routine enrollment and contract matters, as appropriate.
• Performs detailed follow-up activities on assigned accounts according to procedures.
• Maintains confidentiality of all provider enrollment business/work and medical staff information.
• Participates in special projects/assignments.
• Performs other duties as assigned.

Required Education

Associates degree in Business Administration or closely related field.

Required Experience

Three (3) years of financial, credentialing, billing or related experience in a healthcare organization, or Five (5) years of the required experience with a High School Diploma.