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Provider Enrollment Specialist
1 month ago
Provider Enrollment Specialist- Houston, Texas
SPC provides fully integrative behavioral health services to the long-term care patient within their facility. Services include the following: individual, family, and group therapies (along with diagnostic evaluation and collaborative intervention between the therapy team and the psychiatric team). Our multi-disciplinary team realizes that older adults have special physical, emotional, and social needs. The psychiatrist leads a team of nurse practitioners, physician assistants, and psychotherapists (LCSW, LPC, PhD/PsyD) while taking a comprehensive approach to diagnosis and treatment.
BASIC RESPONSIBILITIES
Position is responsible for the overall Credentialing/Provider Enrollment for the company, SPC. This encompasses provider enrollments as well as administrative activities pertaining to maintenance of credentialing documents in provider’s records.
SPECIFIC RESPONSIBILITIES
- Collects all credentialing documents i.e. professional licenses, diploma and or/transcripts, National Certifications, DEA/DPS and malpractice certificates.
- Reviews license for any board orders or disciplinary actions.
- Runs initial check to verify that provider is not on exclusion lists in the SAM and OIG databases as well as routine monthly checks.
- Creates a Login through the Identity & Access Management System (I&A) and requests NPI # for new providers that do not already have an NPI#.
- Adds new provider to SPC’s account with the National Provider Data Bank for continuous querying.
- Creates and sends Prescriptive Authority Agreement to Physicians and Mid-Levels via DocuSign.
- Keeps track of supervision hours and prescriptive delegation between Physicians and Mid-Levels and ensures that Mid-Level shows linked to Supervising Physician on TMB website.
- Maintains list of providers with board orders, disciplinary actions and criminal charges that will need to be disclosed with provider’s enrollments.
- Creates and maintains Provider’s CAQH account.
- Processes enrollments as well as re-enrollments for the company’s groups and all performing providers.
- Process Provider Enrollment with Medicare, Medicaid, RR MCR and various MCOs and commercial insurance companies.
- Makes routine follow up calls and emails for status updates on all enrollments that are processing.
- Processes EDI and EFT for new group enrollments.
- Maintains TMHP, Optum Provider Portals and other directories for SPC groups.
- Maintains spreadsheet of Providers License, Registration and Certification expiration dates. E-mails Provider and cc’s Regional Mgr. notifying them 60 and 30 days prior to expiration.
- Uploads provider’s licenses to Medicaid Provider Enrollment before expiration.
- Creates logins in IMS for new employees and emails credentials to employees
- Maintains spreadsheet of groups and provider’s individual billing numbers.
- Enter credentialing updates into Access, IMS and Monday software.
- Processes 855B to enroll new nursing home location to Medicare per pay locality.
- Completes provider credentialing packets for nursing homes and sends copies of provider’s licenses and malpractice certificates as requested.
- Will be fully cross trained, and act as back up as needed for HR department.
- Other duties as required by the function.
QUALIFICATIONS/REQUIREMENTS
- Associate degree preferred.
- 1-2 years of previous credentialing and provider enrollment or similar experience in a field where detailed work is required.
- Strong and proven attention to detail, mathematical and computational skills.
- Work accuracy, timeliness and organization are required.
- Intermediate to advanced MS office skills (Outlook, Word, Excel and Access) are required. Advanced skills in web based applications preferred.
- Ability to handle multiple employee demands with tact, discretion and courtesy.
- Effective verbal and written communications skills. Ability to speak publicly and effectively communicate information to individuals or a group of employees.
- Ability to work independently and/or in a team-oriented environment, and be proactive.
- Valid driver’s license and automobile liability insurance as required by law is required.
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