Provider Enrollment Specialist

2 weeks ago

Irving, Texas, United States Impresiv Health Full time
Job Title: Provider Enrollment Specialist

At Impresiv Health, we are seeking a highly skilled and detail-oriented Provider Enrollment Specialist to join our team. As a key member of our operations team, you will be responsible for coordinating Medicare and Medicaid enrollment/re-enrollment and managed care credentialing and contracting processes for providers.

Key Responsibilities:
  • Collect and maintain data on providers for Medicare and Medicaid enrollment.
  • Prepare and submit applications to Medicare and Medicaid for new provider enrollments and existing provider updates.
  • Follow up with carriers regarding application status.
  • Comply with Medicare and Medicaid provider enrollment guidelines.
  • Request NPI numbers for providers and clinics as necessary and maintain NPI files.
  • Follow up with insurance companies and patients regarding the processing of outstanding claims and/or appeals.
  • Generate various reports to identify outstanding claims issues with provider numbers and non-payment.
  • Communicate information to appropriate personnel.
  • Educate staff on corrections, e.g., front-end entry errors in a positive, constructive manner.
  • Collect and review managed care contracts for correct billing and payment terms.
  • Identify problem accounts and follow through to completion.
  • Review Athena correspondence and unpostables.
  • Participate in company-sponsored enrollment/credentialing meetings and other educational activities.
  • Participate in Billing System Training exercises and updates.
  • Assist in training on the Billing System software package when necessary.
  • Serve as a Superuser of the Billing System to be available to answer questions from the various clinics.
  • Follow the company guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI).
  • Maintain strict confidentiality.
  • Use oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with the company's Mission.
  • Maintain established company policies, procedures, objectives, quality assurance, safety, environmental, and infection control.
  • Implement job responsibilities in a manner that is consistent with the company's Mission and Code of Ethics and supportive of company Physician Group's cultural diversity objectives.
Requirements:
  • High School Diploma required.
  • 1-3 years of Payer Enrollment experience required.
  • Solid knowledge and utilization of PC applications to include Word, Excel, Access.
  • Excellent written and verbal communication skills.
  • Excellent organization and planning skills with demonstrated teamwork skills.
  • Proven ability to interact with all levels of management and other Associates.

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