Provider Enrollment Compliance - Coordinator 1

University of New Orleans•Baton Rouge, LA

About The Position

Monitors the Provider Enrollment (PE) Unit of the Fiscal Intermediary (FI), including enrollment and maintenance for more than 100 provider types and over 65,000 providers. Ensures that Medicaid Provider Subsystem activities remain compliant with federal and state regulations and with legislative or independent audit findings. The role serves as the Provider Enrollment subject matter expert and monitors and assists the FI with PE operations, contractual compliance, statistics, and system or process changes. The coordinator works with LDH staff, agency bureaus and offices, contractors, state teaching facilities, providers, program staff, and federal regulatory agencies. The role monitors proposed and current regulations, coordinates implementation of policy changes affecting providers, and participates in strategy development with the FI. It also supports the Provider Management Project, ACA compliance procedures, enrollment application and manual revisions, provider workshops and training, and Medicaid projects as assigned.

Requirements

Bachelor's degree, or an associate degree with 3 years of professional experience, or 6 years of professional experience in lieu of a degree.
Excellent analytical skills.
Effective organizational and time-management skills.
Great attention to detail and follow-up.
Ability to manage projects, assignments, and competing priorities.
Proficiency with Microsoft Office, including Outlook, Word, and Excel.

Nice To Haves

Advanced degree.
At least 1 year of professional experience in healthcare compliance auditing, provider enrollment, or credentialing.
At least 1 year of professional experience working with Medicaid program support.
At least 1 year of professional experience with claims processing and billing.
Knowledge of CPT, ICD-9 or ICD-10 coding, and HCPCS.

Responsibilities

Monitor enrollment and maintenance activities for more than 100 provider types and over 65,000 providers.
Monitor Medicaid Provider Subsystem activities for compliance with federal and state regulations and legislative or independent audit findings.
Recommend criteria for closing and removing inactive provider files from the MMIS provider subsystem.
Coordinate with agency bureaus and offices, contractors, and state teaching facilities on eligibility for provider types with complex enrollment requirements.
Monitor current and proposed state and federal regulations and clarifications for their impact on program and system functions.
Communicate with federal regulatory agencies, FI staff, providers, and program staff about program and system changes, enhancements, and integrity.
Attend meetings and participate in strategy development to coordinate and implement policy changes affecting providers.
Assist with development and implementation of the Provider Management Project.
Serve as the Provider Enrollment subject matter expert and monitor and assist the FI with day-to-day PE operations.
Act as liaison between LDH staff and the FI regarding design changes, ECHOS, file or form discrepancies, and special requests.
Keep LDH management informed about new developments, major changes, and issues.
Consult with internal staff and external agencies regarding Provider Enrollment issues.
Assist with procedures for maintaining Provider Enrollment compliance with Affordable Care Act mandates.
Coordinate, participate in, review, and approve revisions to enrollment applications, forms, and manuals.
Research, develop, or direct small Medicaid projects as assigned.
Assist Program Integrity staff with enrollment files for compliance purposes.
Assist program staff with creating new provider types and enrollment packets.
Participate in provider workshops, seminars, or training as requested.
Monitor PE statistics produced by the FI and the FI's compliance with contractual obligations.
Perform other duties as assigned.