Provider Enrollment

Position Summary

The Provider Enrollment Specialist administers the electronic funds transfer (EFT) enrollment and credentialing applications process. The Provider Enrollment Specialist is responsible for preparing and submitting EFT applications and supporting documentation for the purpose of updating banking information. In this role, you will provide the necessary information for the setup of our billing system and assist with any electronic remittance advice setup that is needed. You will follow up on the status of applications for insurance payors, and track progress on all pending applications.

Essential Duties and Responsibilities

The essential functions include, but are not limited to the following:

* Handle confidential information and protected health information (PHI) with tact and discretion as outlined in compliance with the Health Insurance Portability and Protection Act (HIPPA).

* Implement the EFT enrollment and credentialing process. Maintain the timelines on enrollment schedules, 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.

* Coordinate and facilitate troubleshooting with payer networks to resolve any issues related to enrollments.

* Coordinate setup of provider in the clearinghouse as well as related ERA & EFT setup.

* Obtain required client signatures and follow-up with the carriers on documentation submitted.

* Maintain provider information and demographics for all providers.

* Respond to internal and external inquiries on routine enrollment and contract matters.

* Performs other duties as requested or assigned by Director of Revenue Cycle and/or management.

Minimum Qualifications (Knowledge, Skills, and Abilities)

* High School Diploma or equivalent education/experience within the medical enrollment/EFT enrollments field

* Minimum of three years of related experience

* Knowledge of Availity platform

* Knowledge of medical insurance carrier policies and procedures and state and federal rules and regulations

* Medicare, Medicaid, and Commercial Payer Provided Enrollment knowledge

* Proficiency in Microsoft Office Suite/Office 365 (particularly Excel and Word)

* Professional written and verbal communication and interpersonal skills and ability to communicate effectively with team members, supervisors, client staff, and insurance contacts

* Ability to maintain complete confidentiality in handling sensitive enrollment issues

* Ability to work in a typical office environment involving sitting or standing for long periods of time, working on a computer for long periods, and some lifting and carrying.

Hours: Mon-Fri 8am-4:30pm

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