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Provider Enrollment Specialist

2 months ago

Detroit, United States Henry Ford Health System Full time

This non-exempt role will require availability to work in person at the Henry Ford Health Corporate Office at One Ford Place in Detroit.

GENERAL SUMMARY:

Under general supervision, responsible for all functions relating to ensuring that all appropriate practitioners are enrolled in government programs and commercial health plans. Primary responsibilities include taking a new provider application from receipt to inclusion in directory and making ongoing updates. Responsibilities include data entry, data collection, analysis of information collected for appropriate enrollment. The Provider Enrollment Specialist must be knowledgeable to work in all aspects of the insurance provider enrollment process including initial enrollment, re-credentialing or revalidation. Provider Enrollment Specialist ensures providers are enrolled in accordance with current standards and regulations and must maintain stringent compliance with payers. The Provider Enrollment Specialist maintains excellent relations and is the main liaison between payers, clinics, and providers to assure participation status is managed in a timely and accurate manner.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

  • Responsible for comprehensive and precise data entry for maintaining the accuracy of the enrollment database.

  • Responsible for following department database standards for the documentation of all health plans and products, documents, and notes on incoming and outgoing attempts to obtain information and follow up conversations.

  • In depth working knowledge of various payor applications associated with the workflow process, i.e., Webdenis, CHAMPS, PECOS, CAQH.

  • Follows the Network Management workflow process in real time meeting required turnaround times and accuracy rates.

  • Verifies all required information and obtains necessary documents to ensure providers are processed according to current policies and procedure and ensure all files have a welcome, denial, or term letter, as appropriate.

  • Facilitates research and resolves denied claims & enrollment issues.

  • Possesses in depth knowledge of health plan standards and department operating procedures and effectively communicates issues, trends, concerns among team members and interdepartmental customers.

  • Communicates with internal and external customers in a clear, concise and professional manner to obtain or provide necessary information.

  • Organize and maintain practitioner files following confidentiality guidelines.

  • Participates in system integration and continuing quality improvement efforts.

  • Provides support and problem solving to Department Director in the development of short and long-range plans for the department, assuring overall continuity of the corporate strategy.

    EDUCATION/EXPERIENCE REQUIRED:

  • High School Diploma required. Associate’s Degree preferred.

  • 2-5 years of provider enrollment provider billing or credentialing experience required.

  • High level of energy to work in a fast paced constantly changing environment often including time deadlines, frequent interruptions, multiple demands and multi-tasking.

  • Ability to work under minimal supervision.

  • Ability to perform detail work efficiently and with a high degree of accuracy.

  • Highly organized.

  • Strong business acumen.

  • Excellent verbal and written communication skills.

  • Ability to interpret information and make judgments quickly.

  • Ability to interact professionally with practitioners and other external customers

  • Strong quantitative and analytical skills.

  • Computer proficient in Microsoft Office including: Outlook, Word and Excel.

  • Proficient in EPIC, Morrisey, MD Staff.

Additional Information

  • Organization: Corporate Services

  • Department: Central Verification Office

  • Shift: Day Job

  • Union Code: Not Applicable

    Additional Details

    This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above.

Overview

Partnering with nearly 2 million people on their health journey, Henry Ford Health provides a full continuum of services at 250 care locations throughout southeast and south central Michigan. With 33,000 valued team members, Henry Ford is also among Michigan’s largest and most diverse employers. Our superior care and discoveries are powered by nearly 6,000 physicians, researchers and advanced practice providers. Learn more athenryford.com.

Benefits

Whether it's offering a new medical option, helping you make healthier lifestyle choices or making the employee enrollment selection experience easier, it's all about choice. Henry Ford Health has a new approach for its employee benefits program - My Choice Rewards. My Choice Rewards is a program as diverse as the people it serves. There are dozens of options for all of our employees including compensation, benefits, work/life balance and learning - options that enhance your career and add value to your personal life. As an employee you are provided access to Retirement Programs, an Employee Assistance Program (Henry Ford Enhanced), Tuition Reimbursement, Paid Time Off, Employee Health and Wellness, and a whole host of other benefits and services. Employee's classified as contingent status are not eligible for benefits.

Equal Employment Opportunity/Affirmative Action Employer

Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.