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Provider Enrollment Coordinator

2 weeks ago

Dallas, Texas, United States Integrative Emergency Services Full time

Integrative Emergency Services, LLC ("IES") is looking for a Provider Enrollment Coordinator to liaison with our RCM vendors and facilitate the enrollment process (submitting of applications) of Providers and Provider Groups (Rosters) with the various government and insurance healthcare payors and network managed care contracting plans. Will be responsible for gathering and relaying required information, per payor requirements, to our RCM partners. This role will be responsible for following up with payors and RCM partners, on enrollment and roster statuses. Responsible for updating internal systems and ensuring smooth and timely initial and ongoing network participation of the Physician Groups in the various contracted insurance plans. 

This position will support states where we operate in that include, but are not limited to: Arizona, Colorado, Texas, Oklahoma, Alabama, Indiana, Missouri, South Carolina, and Florida. This position is also responsible for the accounts receivable on hold pending provider number assignment by the payors.

IES is dedicated to cultivating best practices in emergency care, providing comprehensive acute care services, creating value, and supporting patients, employees, clients, providers, and physicians in pursuit of the highest quality health care. 

Role will be a hybrid schedule, typically Tuesday-Thursday in office, at 4835 LBJ FWY, Dallas, TX, 75244

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following.  Others may be assigned.

Follow established enrollment procedures and best practices directly or by working with Enrollment Coordinators.Partner with in-house and third-party RCM partners for current applications, system updates, and identifying/resolving problems. Prepares applications for new providers for multiple contracts sites, payors, and states Submit required information to RCM vendors per payor contract requirements Follow up with RCM vendors and payers to ensure timely approval of network participationUpdate Enrollment Master Reports and track application submissions, re-validations, and re-enrollment for all providers and groups.Partner with RCM vendors in the management of claim corrections or rejections due to enrollment errors and/or claim submission requirements.Ensures Held A/R enrollments are submitted on timely basis to avoid risk of claims/adjustments and an unnecessary increase of Held AR. Maintain and work reports of held A/R to maximize income opportunities.Accountable for meeting Enrollment performance standards and timing deadlinesConveys issues and status of problems to Enrollment Manager. Completes CAQH applications for new and existing providers. Will maintain CAQH reporting and attest provider applications every 120 days. Assist and maintain enrollment reporting for different payors including Superior Health, Healthscope, and Cigna.Adheres to all company policies and procedures.Works independently within the scope of responsibility and authority.

QUALIFICATIONS

Knowledge, Skills, Abilities:  To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Understands and follows state and payor requirements, some of which are quite complex, and determines which applications require management approval or special processing requirements.Able to work with high volume enrollments while multi-tasking and driving provider enrollments through completion.Ability to handle frequent verbal and written communications with Clinicians, state payors, insurance carriers, third party billing company and internal company staff requiring professionalism and tact to attain or provide all needed information quickly in order to expedite the enrollment of Clinicians in the various plans to maximize billing opportunities.Excellent analytical, organizational, and verbal/written communication skills.  Strong telephone skills.Ability to manage multiple priorities with high attention to detail within a high volume fast paced environmentStrong customer service orientationAbility to use discretion appropriately and maintain confidentialityHigh levels of proficiency with MS Office applications, especially Microsoft Word and ExcelAbility to read, write and speak English proficiently

Education / Experience:  Include minimum education, technical training, and/or experience preferred to perform the job.

Required:

High School Diploma Minimum 1 year previous provider payor enrollment (individual provider and group enrollment) or related experience Ability to obtain, set-up, maintain, and reattest CAQH profilesPrior government healthcare payor experience

Preferred:

Bachelor's degree Enrollment experience with both Commercial and Government Plans Multi-state Enrollment Experience 

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

Specific vision requirements include the ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focusWhile performing the duties of this job, the employee is regularly required to talk and hearFrequently required to stand, walk, sit, use hands to feel, and reach with hands and armsPossess the ability to fulfill any office activities normally expected in an office setting, to include, but not limited to:  remaining seated for periods of time to perform computer based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.)Occasionally lift and/or move up to 20-25 pounds  Fine hand manipulation (keyboarding)

WORK ENVIRONMENT:  The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Corporate Office at 4835 Lyndon B Johnson Fwy #900, Dallas, TX 75244Typical in-office days are Tuesday, Wednesday, ThursdayCore business hours are typically 8:30am - 5pmThe noise level in the work environment is usually low

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.



The company is committed to creating a diverse, inclusive, and equitable environment and is proud to be an equal opportunity employer. Qualified applicants of any age, race, religion, nationality, sexual orientation, gender identity or expression, disability, or veteran status will receive equal consideration for positions. We welcome people of diverse backgrounds, experiences, and abilities and believe that the unique experiences of our team drive our success.