Provider Enrollment Specialist

3 weeks ago

Richardson, United States National Partners in Healthcare Full time

Company Overview

National Partners in Healthcare (NPH) is a progressive healthcare company specializing in anesthesiology. We partner with physicians and health systems to deliver high quality care, aligning synergies and best practices to achieve superior outcomes. As a leader in the industry, we believe in developing a foundation of trust, transparency, and excellence in everything we do. The success of our company has created excellent career advancement opportunities that support a healthy work/life balance.

Essential Duties and Responsibilities:

* Prepare initial payer enrollment applications for all new providers and new NPH groups
* Timely revalidate and re-enroll providers with government and contracted payors
* Send pre-populated applications to the providers for completion
* Maintains knowledge of current payor requirements
* Audits payor internal directories for current and accurate provider information
* Set up new NPH Entities with the health plans when we entering new states
* Complete electronic payer enrollment applications with various payers including government payers (Medicare/Medicaid)
* Prepare initial CAQH application for new providers and maintain the CAQH reattestation of provider profiles on quarterly basis
* Prepare cover letter to include all documents that need to be returned with applications.
* Prepare all Federal Express mailing envelopes and returns for packets.
* Track and follow up with providers for timely return of all required documents and applications.
* Submit applications to payors.
* Track and follow up with payors to obtain status on provider application process to ensure applications are being processed in a timely manner
* Notify various departments of new hires and termed providers
* Responsible for generating various standard and ad hoc reports from database
* Responsible for updating the Ops report with provider enrollment status
* Maintain and work reports of non-compliant providers and held A/R.
* Process applications government and managed care entities; contacts providers regarding missing information when necessary
* Ensures the data integrity of the enrollment system
* Reviews all applications and other provider enrollment information for thoroughness and completion prior to being sent to government entities, managed care plans or internal department and management
* Continually maintain the highest level of customer service within the department
* Maintains close contact with division heads, providers, administrators, managed care department and internal departments regarding status of applications and provider enrollment process.
* Work closely with Provider Recruiter, Operations and Human Resources to maintain accurate provider headcount and status of all recruits.
* Maintains provider files and provider enrollment documentation
* Responsible for generating various standard and ad hoc reports from database
* Escalate all payer issues to manager for resolution, as deemed necessary.
* Help to identify process improvement methods and ways to automate processes to increase efficiencies
* Submission of EFT/ERA applications
* Maintain EFT/ERA Spreadsheet
* Claim denial resolution as it relates to payer enrollment
* Adhere to all company policies and procedures.
* Adherence to and compliance with information systems security is everyones responsibility. It is the responsibility of every computer user to: Know and follow Information Systems security policies and procedures. Attend Information Systems security training, when offered. Report information systems security problems..

Education/Licensing/Certification:

* High School Diploma or equivalent

Experience:

*
* 1-2 years experience in healthcare industry
* 2 years provider enrollment and/or revenue cycle experience preferred





Knowledge and Skills:

* Basic knowledge in the process of enrolling and/or credentialing physicians and ancillary providers
* Basic knowledge in provider enrollment process.
* Basic knowlege in revenue cycle process
* Basic knowledge of managed care
* Experience with enrollment based software, NPPEs, and PECOS preferred
* Proficient Medicare and Medicaid, BCBS, UHC, Aetna, multi-state payor enrollment experience desired.
* Proficient in enrollment in CAQH/Availty preferred
* Ability to work cooperatively with physicians, mid-levels, all staff members and external customers.
* Basic medical terminology
* Develop working knowledge of payor policies for multiple states.
* Capable of meeting time-sensitive deadlines and multi-tasking. (timely filing of applications)
* Working knowledge of computers and ability to use word-processing, spreadsheet and data base programs.
* Strong attention to accuracy and detail.
* Exceptional organizational skills and multi-tasking skills.
* Ability to work independently with minimal supervision
* Ability to interact and communicate effectively with all internal staff and contacts outside the organization
* Ability to communicate effectively, both in writing and verbally.
* Must have a pleasant disposition and high tolerance level for diverse personalities.

Advantages of Working at NPH

* Competitive Pay and Benefits Package
* Annual Bonus
* Generous Paid Time Off
* 401K Contribution/Safe Harbor
* Flexible Work Environment
* Career Advancement Opportunities with a Growing Company
* On-site Fitness Center and Café
* Underground Parking with Badge Access

Please note that quoted salary ranges are not guarantees of what final salary offers may be. Base pay is based on market location and will vary depending on job-related knowledge, skills, and experience. Base pay is only one part of the Total Rewards that NPH provides to compensate and recognize our staff for their work. Full time positions are eligible for a discretionary bonus and a comprehensive benefits package.

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