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Provider Enrollment Representative

2 months ago

Silver Spring, United States Children's National Hospital Full time

The Provider Enrollment Representative will facilitate activities from the point of the provider candidate's acceptance of employment to the point of the candidate's approved enrollment with DC, Maryland, Virginia and West Virginia Medicaid and Medicare. The purpose of this position is to provide an efficient process to ensure that our new providers are enrolled prior to activation of privileges. The representative will work in concert with Medical Staff Services, the individual providers, department administrators and leadership to complete the enrollment applications and submit with all related credentials, licensing and other payer specific requirements. The Provider Enrollment Representative is a critical member of the Revenue Cycle and CNH organization teams for ensuring that providers are enrolled and prepared to begin working by the time of Board approval.

Qualifications:
Minimum Education
High School Diploma or GED (Required)
Associate's Degree (Preferred)

Minimum Work Experience
3 years Experience in customer service in a healthcare setting, professional billing or denial resolutions based on in-network and provider enrollment requirements
(Required) Or
3 years Experience in provider medical licensing and State and Federal enrollment processes and applications. (Preferred)

Required Skills/Knowledge
Superior ability to interface effectively with providers, provider leadership, internal departments and external agencies.
Superior administrative skills to include strong organizational skills and the ability to multi-task.
Extreme attention to detail and ability to focus and perform without supervision.
Superior communication skills both written and oral.
Internet and computer skills to include intermediate Excel and Word
Knowledge of healthcare and professional provider services

Functional Accountabilities
Documenting accepted and eligible provider

  • Partner with Medical Staff Services to ensure capture of the new onboarding providers and identify those that are eligible for enrollment.
  • Partner with Medical Staff Services to ensure that the CNH credentialing system is open for documenting enrollment activity and provider status
  • Create and maintain accurate and detailed Excel rosters with required data to share, record, track and follow-up for enrollment activity
  • Create and maintain archive files for storage and audit.
Provider License and Credential Activities
  • Research for and coordinate licensure activities with MSS and the provider for the three jurisdictions for licenses, controlled substance certificates and DEA registrations and internally for the certificate of insurance.
  • Follow-up for missing or delayed credentials and license documents within the defined timelines.
  • Follow defined process and timelines escalating problems to the provider, department administrator and leadership for problems that will prohibit enrollment applications from filing within the expected time frames.
Enrollment Activities
  • Following defined payer guidelines create individual provider accounts with state and federal payers.
  • Following defined payer guidelines complete online applications for DC, Maryland, Virginia and West Virginia Medicaid and within the required time frame.
  • Following defined CMS guidelines complete PECOS and/or online application for Medicare and within the required time frame.
  • Coordinate the required supporting documents with the application as defined by state and federal requirements.
  • Document and track submission of the application to ensure receipt by the payer
  • Working with the provider research and resolve license, data or NPPES registry problems related to denied or rejected applications within the required time frame.
Communication/Team
  • Team with Business Operations, Medical Staff Services, Managed Care, the individual provider and department leadership to communicate enrollment activity and related problems and work together to resolve while providing superior customer service and communication.
  • Exhibit superior customer service and communications to providers, division chiefs and management
  • Partner with insurance companies to problem solve application or system related problems.
Supporting Enrollments
  • Participate in projects related to payer changes and annual maintenance of provider enrollments new and established.
  • Participate in projects related to resolving established provider enrollment problems
Organizational Accountabilities
Organizational Accountabilities (Staff)
Organizational Commitment/Identification
  • Anticipate and responds to customer needs; follows up until needs are met
Teamwork/Communication
  • Demonstrate collaborative and respectful behavior
  • Partner with all team members to achieve goals
  • Receptive to others' ideas and opinions
Performance Improvement/Problem-solving
  • Contribute to a positive work environment
  • Demonstrate flexibility and willingness to change
  • Identify opportunities to improve clinical and administrative processes
  • Make appropriate decisions, using sound judgment
Cost Management/Financial Responsibility
  • Use resources efficiently
  • Search for less costly ways of doing things
Safety
  • Speak up when team members appear to exhibit unsafe behavior or performance
  • Continuously validate and verify information needed for decision making or documentation
  • Stop in the face of uncertainty and takes time to resolve the situation
  • Demonstrate accurate, clear and timely verbal and written communication
  • Actively promote safety for patients, families, visitors and co-workers
  • Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance