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Provider Enrollment Specialist

2 months ago

Irving, Texas, United States Della Infotech Full time
Job Description

Job Summary:

We are seeking a highly skilled Provider Enrollment Specialist to join our team at Della Infotech. The successful candidate will be responsible for collecting and maintaining data on providers for Medicare and Medicaid enrollment, preparing and submitting applications, and following up with carriers regarding application status.

Key Responsibilities:

  • Collects and maintains data on providers for Medicare and Medicaid enrollment
  • Prepares and submits applications to Medicare and Medicaid for new provider enrollments and existing provider updates
  • Follows up with carriers regarding application status
  • Complies with Medicare and Medicaid provider enrollment guidelines
  • Requests NPI numbers for providers and clinics as necessary and maintains NPI files
  • Follows up with insurance companies and patients regarding the processing of outstanding claims and/or appeals
  • Generates various reports to identify outstanding claims issues with provider numbers and non-payment
  • Communicates information to appropriate personnel
  • Educates staff on corrections, e.g. front-end entry errors in a positive, constructive manner
  • Collects and reviews managed care contracts for correct billing and payment terms
  • Identifies problem accounts and follows through to completion
  • Reviews Athena's correspondence and unpotable
  • Participates in company-sponsored enrollment/credentialing meetings and other educational activities
  • Participates in Billing System Training exercises and updates
  • Assists in training on the Billing System software package when necessary
  • Serves as a Superuser of the Billing System to be available to answer questions from the various clinics
  • Follows the CHRISTUS guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
  • Maintains strict confidentiality
  • Uses oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with the CHRISTUS Mission
  • Maintains established CHRISTUS policies, procedures, objectives, quality assurance, safety, environmental, and infection control

Requirements:

  • High School Diploma
  • 1-3 years of Payer Enrollment experience
  • 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

Working at Della Infotech:

We are a dynamic and innovative company that values our employees and provides a supportive and inclusive work environment. We offer competitive salaries, comprehensive benefits, and opportunities for professional growth and development.