North Country HealthCare AZ
  • Flagstaff, AZ, USA
  • Full Time

Provider Enrollment Specialist




GENERAL DESCRIPTION OF POSITION
The Provider Enrollment Specialist is responsible for coordinating, monitoring, and maintaining the provider and facility enrollment and re-enrollment process in a timely and compliant manner with all government and commercial payors. Assists with problem identification and timely resolution of payor related issues surrounding claim submission and denial management to ensure optimal reimbursement.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  1. Prepare and maintain enrollment credentialing files and reports for all individual providers including maintenance of credentialing software, provider rosters, and spreadsheets to comply with payor and organizational requirements. This duty is performed daily, about 50% of the time.

  2. Process and file applications with third-party payors according to each payor's individual requirements and address/corrects discrepancies as requested by payors. This duty is performed daily, about 30% of the time.

  3. Conduct all follow-up steps until payor approval/completion is obtained. This duty is performed weekly, about 30% of the time.

  4. File provider practice changes notifications and performs follow-up duties until confirmed complete by payors. This duty is performed monthly, about 10% of the time.

  5. Update NPI records according to provider specifications. This duty is performed monthly, about 10% of the time.

  6. Enroll provider in Medicare/Medicaid as prescribed by each program requirements. This duty is performed daily, about 5% of the time.

  7. Ensure timely processing of CAQH and other payor updates. This duty is performed daily, about 5% of the time.

  8. Complete requests for re-credentialing for both providers and facilities. This duty is performed weekly, about 30% of the time.

  9. Answer questions, process requests from staff/providers related to enrollment information. This duty is performed daily, about 5% of the time.

  10. Ensure all records meet standards set by carriers as well as FQHC guidelines. This duty is performed weekly, about 20% of the time.

  11. Enrolls facilities in Medicare/Medicaid programs. This duty is performed irregularly, about 50% of the time.

  12. Address enrollment disconnects regarding facility and providers. This duty is performed weekly, about 20% of the time.

  13. Maintains payor specific rosters. This duty is performed weekly, about 20% of the time.

  14. Terminates provider in accordance with payor required timelines. This duty is performed irregularly, about 30% of the time.

  15. Updates expired documents with payors to prevent payor reimbursement denials. This duty is performed monthly, about 50% of the time.

  16. Performs CAQH attestations timely. This duty is performed daily, about 5% of the time.

  17. Assist with clinic licensing and providing documents for new sites or new added services. This duty is performed irregularly, about 10% of the time.

  18. Attend departmental and company meetings. This duty is performed weekly, about 5% of the time.

  19. Performs other duties as assigned. This duty is performed irregularly, about 10% of the time.
  • Regular and predictable attendance.
  • Continuous learning in both personal and professional development.
  • Consistent review, comprehension and reply of company email and related correspondence.



QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty mentioned satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.

EDUCATION AND EXPERIENCE
Knowledge of a specialized field (however acquired), such as basic accounting, computer, etc. equivalent of four years in high school, plus night, trade extension, or correspondence school specialized training, equal to two years of college, plus 2 years related experience and/or training. Or equivalent combination of education and experience.


COMMUNICATION SKILLS
Ability to read and understand documents such as policy manuals, safety rules, operating and maintenance instructions, and procedure manuals; Ability to write routine reports and correspondence. Ability to effectively communicate information and respond to questions in person-to-person and small group situations with customers, clients, general public and other employees of the organization. Ability to write reports, business correspondence, and policy/procedure manuals; Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.


CRITICAL THINKING SKILLS
Ability to solve practical problems and deal with a variety of known variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, or diagram formats.


PUBLIC CONTACT
Regular contacts with patrons, either within the office or in the field. May also involve occasional self-initiated contacts to patrons. Lack of tact and judgment may result in a limited type of problem for the organization.


SOFTWARE SKILLS REQUIRED
Advanced: Alphanumeric Data Entry, Contact Management, Database, Word Processing/Typing
Intermediate: 10-Key, Spreadsheet
Basic: Human Resources Systems, Presentation/PowerPoint


ADDITIONAL INFORMATION
1. Knowledge and understanding of provider and facility enrollment process.
2. Ability to organize and prioritize work and manage multiple priorities.
3. Excellent verbal and written communication skills including letter, memos and emails.
4. Excellent attention to detail.
5. Ability to research and analyze data.
6. Ability to establish and maintain effective working relationships with providers, management, staff and contacts outside the organization.


North Country is a VEVRAA Federal Contractor and Equal Opportunity Employer

Full Job Description
North Country HealthCare AZ
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