Enrollment Specialist

Summit Health Management

14d•$19 - $24•Remote

About The Position

The Enrollment Specialist ensures that all provider enrollment data remains current with the payers and in the Athena practice management system. The Enrollment Specialist assists in preparing and submitting enrollment applications and supporting documentation for the purpose of maintaining participating status for individual physicians, facilities, and privileges. In this role, the enrollment specialist ensures that the providers, facilities, and services are set up for electronic claims submission and remittance. The Revenue Cycle Enrollment Specialist ensures there are no disruptions in the revenue cycle due to lapses in payer enrollment and accreditation.

Requirements

Bachelor's degree preferred
Minimum of 1 year experience in healthcare or provider enrollment/credentialing
Knowledge of Commercial and Government insurance carrier policies and procedures as they relate to enrollment
Proficiency in Microsoft Office, particularly Excel and Word
Professional written and verbal communication and interpersonal skills required
Ability to motivate teams as well as, participate and facilitate group meeting
Ability to effectively communicate with providers, managers, clinical staff and insurance contacts
Ability to maintain complete confidentiality in handling sensitive enrollment issues

Responsibilities

Manage Athena enrollment tasks dashboard to ensure provider/department/facility data is accurate and complete
Knowledgeable of payer enrollment policies and updates internal documents and checklists according to department guidelines
Assist to complete initial credentialing applications for new facility enrollment, and supplies supporting documentation as required by commercial and government payers
Perform assigned tasks required to maintain the timelines for enrollment schedules and ensure documentation is updated and submitted as required to avoid a disruption in participating status and revenue
Audit provider rosters and payer directories. Provides updated provider files to the payers ensure payer files are accurate and current
Assist to coordinate enrollment data and other accreditations with the Credentialing Department
Knowledgeable of the delegated credentialing process
Respond to internal and external inquiries on routine enrollment and privileging matter
Maintain a strict level of confidentiality for all matters pertaining to provider enrollment
Perform other duties as requested
Work closely with managers, providers and clinical staff to obtain and verify the documentation and signatures necessary to process Medicare initial enrollments, Revalidations, and initial Medicaid non-billing enrollments
Follow up with all payers to ensure enrollment documentation is received and updated in a timely manner
Follow up with payers to resolve the billing issues related to enrollment and ensure claims are reprocessed for payment as payer systems are updated
Assist in researching claim denials and trends related to enrollment and billing