Payer Activation Specialist
About The Position
The Payer Activation Specialist coordinates all application processes regarding enrollments for Medicare, Railroad Medicare, Tricare, and Medicaid for professional providers. This role is responsible for maintaining knowledge of enrollment rules, forms, and processes for various provider types and ensuring all expiration dates are up-to-date. The specialist will maintain provider folders and files with strict confidentiality, collaborate with providers on NPI applications and updates, and plan key communications to prevent lapses in provider enrollment that could result in revenue loss. This position serves as an expert on enrollments and related issues for various departments and external entities, and is responsible for activating and maintaining provider enrollment tables within Epic to ensure accurate claims processing. The role also coordinates the resolution of claim edits and denials related to enrollment issues, acting as a liaison between operational leadership and relevant organizations.
Requirements
- High School Graduate.
- Typically requires 5 years of experience in working with an automated patient accounting system.
- Strong understanding of governmental and insurance carrier credentialing process for providers and facilities.
- Knowledge of current Medicare/Medicaid payor guidelines and requirements.
- Strong analytical, organizational, and communication skills essential.
- Must have ability to function in a multi-disciplinary environment.
Nice To Haves
- PECOS experience
- MD-Staff experience
- Experience working with IL and WI Medicare and Medicaid websites
Responsibilities
- Coordinates all application processes (application completion, provider communication, Epic provider set-up, etc.) regarding enrollments for Medicare, Railroad Medicare, Tricare, and Medicaid for professional providers and communicates all updates to appropriate areas.
- Responsible for maintaining knowledge of enrollment rules/forms/processes for National Provider Identifier (NPI), Medicare, Railroad Medicare, Tricare and Medicaid (including other state programs) for all provider types.
- Responsible for maintaining all expiration dates for all providers enrolled.
- Maintains enrollment and re-validation process.
- Maintains providers folders/files containing provider enrollment documents, signatures and forms while maintaining strict confidentiality.
- Collaborates with providers to apply for an NPI and perform updates/corrections on the National Plan and Provider Enumeration System (NPPES).
- Plans key communication with clinic operational leadership, provider affairs, managed care and credentialed verification team to ensure there are no lapses in provider enrollment that would result in loss of revenue.
- Serves as an expert to the hospital-based clinics, medical groups sites, revenue-producing hospital departments, third party payers, and other Revenue Cycle teams regarding enrollments and enrollment-related issues.
- Responsible for activating and maintaining all provider enrollment tables within Epic to ensure claims are released to the payers only once provider credentialing/enrollment finalized.
- Coordinates the resolution of claim edits related to NPI, CLIAs, tax IDs, and provider enrollment table.
- Acts as a liaison between clinic operational leadership and Advocate Physician Partners (APP) and the Center for Practitioner Information (CPI).
- Coordinates the resolution of denials related to enrollment issues.
- Collaborates with Advocate Physician Partners (APP) and the Center for Practitioner Information (CPI) on the resolution of denials related to non-credentialed providers.
Benefits
- Comprehensive suite of Total Rewards: benefits and well-being programs
- Competitive compensation
- Generous retirement offerings
- Programs that invest in your career development
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
