Provider Enrollment Specialist

Navajo Preference Employment Act :
In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference.

Overview:

POSITION SUMMARY

The primary purpose of this position is to enroll providers, clinicians, clinic locations, and clinical services with third party enrollment entities, such as Medicare, Medicaid, Commercial Insurance entities and the National Plan and Provider Enumeration System. The incumbent must analyze and use discretionary judgment in implementing provider enrollment guidelines to ensure all provider agreements and applications are accurate, current, and maintained.

NECESSARY QUALIFICATIONS

Education:

High School Diploma or GED

Experience:

Must have one (1) year general administrative experience in a patient accounting setting.

Other Skills and Abilities:

A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas:

• Positive working relationships with others
• Possession of high ethical standards and no history of complaints
• Has the ability to handle sensitive and confidential information
• Professional and effective interaction skills with co-workers, clients, Providers, vendors
• Ability to remain organized with multiple interruptions.
• Knowledge of the operations of the front-line staff in a medical practice
• Excellent customer service skills
• Completion of and, above-satisfactory scores on all job interviews, demonstrating to the satisfaction of the interviewees and TCRHCC that the applicant can perform the essential functions of the
• Successful completion of and positive results from all background and reference checks, including positive employment references from authorized representatives of past and current employers demonstrating to the satisfaction of TCRHCC a record of satisfactory performance and that the applicant can perform the essential functions of the
• Successful completion of fingerprint clearance requirements, physical examinations, and other screenings indicating that the applicant is qualified to be employed by TCRHCC and demonstrating to the satisfaction of TCRHCC that the applicant can perform the essential functions of the job
• Submission of all required employment-related documents, applications, resumes, references, and other required information free of false, misleading, or incomplete information, as determined by TCRHCC.

MENTAL AND PHYSICAL EFFORT

The physical and mental demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Physical:

The work is primarily sedentary: sit for prolonged periods of the time. Stand and walk frequently. as interaction between all disciplines within the facility is required, ability to drive, bend, climb, kneel, crouch, twist, maintain balance and reach occasionally... Incumbent will be required to be able to lift 0 to 75 pounds occasionally. Incumbent must be able to push/pull up 50 pounds occasionally. Sensory requirements include the ability for far, near, color vision; depth perception; seeing fine details; hearing normal speech occasionally during workday. Must be able to use the telephone for prolonged period of workday. Incumbent must be able to utilize hand manipulation for simple/firm grasping, fine manipulation occasionally and use of keyboards frequently.

Mental:

The incumbent should have the ability to work alone, demonstrate high degree of patience, work in areas that are close and crowded frequently. The incumbent must exercise a high degree of cope with high level of stress, make decision under high pressure, cope with anger/fear/hostility of other in a calm way, manage altercations, concentrate, handle a high degree of flexibility, handle multiple priorities in a stress situation and adapt to shift work occasionally. Incumbent may be exposed to Infectious diseases, dust, fumes, gases, extremes in temperature or humidity, hazardous moving equipment, unprotected heights, and loud noises occasionally.

ESSENTIAL FUNCTIONS:

1. Prepares initial provider enrollment applications for submission by conferring with appropriate individuals and/or departments to verify information and collects appropriate licensure or certification information as required by the provider (i.e. Medicare, Medicaid, Commercial, National Provider Identifier, regulatory agencies, etc.).
2. Researches conditions of participation upon notification of expansion of clinical services or location and prepares initial provider enrollment applications as required by the provider (i.e. Medicare, Medicaid, Commercial, National Provider Identifier, regulatory agencies, etc.).
3. Responsible for submission of completed applications and for tracking the status of pending enrollment applications by utilizing available tools (i.e. on-line, telephone, internet, etc.) and addresses application discrepancies to ensure confirmation of enrollment.
4. Audits all submitted applications by tracking coverage processing days for applications for initial enrollment, change of information and/or reassignments.
5. Adheres and monitors latest changes in provider enrollment provisions; screening requirements, applicable enrollment fees, and compliance plans/requirements. Informs and educates inter and intra-departmental staff (i.e. supervisors, clinicians, providers, etc.) of changes.
6. Provides assistance to clinical staff members in completing and processing provider enrollment applications. Provides education and orientation to clinical staff and guides them during the enrollment process. Develops reference and training material for inter and intra-departmental staff.
7. Upon receipt of enrollment confirmation or provider separation/changes, enters appropriate provider numbers or changes into the patient accounting systems (i.e. provider maintenance) for third party billing requirements and maintains a comprehensive current list of provider enrollment numbers.
8. Assists patient accounting staff in resolving discrepancies involving provider numbers and/or claims denials as a result of provider number issues.
9. Assist with EHR Incentive Program Enrollments and Attestations for Meaningful Use.
10. Ensure proper PPE is worn at all times while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield.
11. Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updates)
12. Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee, and external customer satisfaction.
13. Performs other duties as assigned.