Provider Enrollment Specialist

1 month ago

Houston, United States Senior PsychCare Full time
Job DescriptionJob DescriptionSalary:

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

  1. Collects all credentialing documents i.e. professional licenses, diploma and or/transcripts, National Certifications, DEA/DPS and malpractice certificates.
  2. Reviews license for any board orders or disciplinary actions.
  3. Runs initial check to verify that provider is not on exclusion lists in the SAM and OIG databases as well as routine monthly checks.
  4. Creates a Login through the Identity & Access Management System (I&A) and requests NPI # for new providers that do not already have an NPI#.
  5. Adds new provider to SPC’s account with the National Provider Data Bank for continuous querying.
  6. Creates and sends Prescriptive Authority Agreement to Physicians and Mid-Levels via DocuSign.
  7. 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.
  8. Maintains list of providers with board orders, disciplinary actions and criminal charges that will need to be disclosed with provider’s enrollments.
  9. Creates and maintains Provider’s CAQH account.
  10. Processes enrollments as well as re-enrollments for the company’s groups and all performing providers.
  11. Process Provider Enrollment with Medicare, Medicaid, RR MCR and various MCOs and commercial insurance companies.
  12. Makes routine follow up calls and emails for status updates on all enrollments that are processing.
  13. Processes EDI and EFT for new group enrollments.
  14. Maintains TMHP, Optum Provider Portals and other directories for SPC groups.
  15. 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.
  16. Uploads provider’s licenses to Medicaid Provider Enrollment before expiration.
  17. Creates logins in IMS for new employees and emails credentials to employees
  18. Maintains spreadsheet of groups and provider’s individual billing numbers.
  19. Enter credentialing updates into Access, IMS and Monday software.
  20. Processes 855B to enroll new nursing home location to Medicare per pay locality.
  21. Completes provider credentialing packets for nursing homes and sends copies of provider’s licenses and malpractice certificates as requested.
  22. Will be fully cross trained, and act as back up as needed for HR department.
  23. Other duties as required by the function.

 

 

 

QUALIFICATIONS/REQUIREMENTS

  1. Associate degree preferred.
  2. 1-2 years of previous credentialing and provider enrollment or similar experience in a field where detailed work is required.
  3. Strong and proven attention to detail, mathematical and computational skills.
  4. Work accuracy, timeliness and organization are required.
  5. Intermediate to advanced MS office skills (Outlook, Word, Excel and Access) are required. Advanced skills in web based applications preferred.
  6. Ability to handle multiple employee demands with tact, discretion and courtesy.
  7. Effective verbal and written communications skills. Ability to speak publicly and effectively communicate information to individuals or a group of employees.
  8. Ability to work independently and/or in a team-oriented environment, and be proactive.
  9. Valid driver’s license and automobile liability insurance as required by law is required.

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