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Provider Enrollment Claims Specialist
2 months ago
SCP Health is a leading provider of clinical practice management services, working to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7,500 providers, and 400 healthcare facilities across 30 states, SCP Health is a trusted partner in the healthcare industry.
Job SummaryWe are seeking a highly skilled Provider Enrollment Claims Specialist to join our team. As a key member of our Provider Enrollment team, you will play a critical role in ensuring the financial stability of our organization by researching and resolving provider enrollment claim denials with government and commercial payors.
Key Responsibilities- Serve as the lead contact for Provider Enrollment claim denials with payors, SCP Medical Collections, Revenue Integrity, Systems, and Managed Care departments.
- Work to resolve high-level, complex payor issues that require in-depth knowledge of both medical billing and provider enrollment/credentialing.
- Research Provider Enrollment related denials, front-end rejections, and correspondence routed to the Claim Specialists assigned ETM Workflow views.
- Contact payors to obtain a clear understanding of denial and changes needed to receive payment.
- Document all correspondence with payors in ETM Task note.
- Assist manager with training of new employees.
- Maintain production requirements determined by Manager.
- Maintain audit score average determined by Manager.
- Daily contact with payors.
- Daily contact with Department Leadership.
- Frequent contact with other SCP Health Departments.
- HS Diploma required.
- 2 years of college required (or 3+ years' experience in Healthcare Revenue Cycle and Provider Enrollment/Credentialing).
- Minimum 4 years' experience in Healthcare Revenue Cycle.
- Agility in managing multiple priorities with strong organizational and time management skills.
- High-level analytical skills pertaining to Revenue Cycle Services in a medical billing environment.
- Experience working with a variety of revenue cycle reports to identify potential issues and trends with payments and/or denials.
- At least 1 year of leadership or management experience.
- Knowledge of Payor Credentialing processes, both Par and Non-Par.
- Knowledge and understanding of Taxonomy codes and how they impact claims.
- Knowledge of CMS Regulations and guidelines.
- Thorough understanding of Explanation of Benefits.
- Proficient in Microsoft Office applications including Word and Excel.
- Ability to foster a cooperative and respectful work environment.
- Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
- Ability to communicate effectively both orally and in writing.
- Experience working with National Provider Identifier database and process.
- Experience working with Medicare, Medicaid, or any Commercial payor.
- Experience working Credentialing/Provider Enrollment denials helpful.
- Centricity/IDX, Athena or other similar medical billing system preferred.
