Provider Enrollment Compliance - Coordinator 1

University of New Orleans•Baton Rouge, LA

17h•$42,000 - $52,000

About The Position

The Provider Enrollment Compliance Coordinator monitors the Provider Enrollment (PE) Unit of the Fiscal Intermediary (FI) and enrollment and maintenance activities for more than 100 provider types and over 65,000 providers. The role monitors the Medicaid Provider Subsystem for compliance with federal and state regulations and with legislative or independent audit findings, and recommends criteria for closing and removing inactive provider files from the MMIS provider subsystem. The Coordinator works with agency bureaus and offices, contractors, state teaching facilities, federal regulatory agencies, FI staff, providers, and program staff to address complex provider eligibility and enrollment matters and coordinate program or system changes. The position serves as the Provider Enrollment subject matter expert and liaison between LDH staff and the FI, supporting the day-to-day operation of PE, the development and implementation of the Provider Management Project, compliance with Affordable Care Act mandates, and other Medicaid projects. The role also reviews and approves revisions to enrollment applications, forms, and manuals; supports Program Integrity and program staff with enrollment files and new provider types; participates in provider workshops, seminars, and training as requested; and monitors PE statistics and the FI’s contractual compliance. Other duties may be assigned.

Requirements

Bachelor’s degree, or 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.
Strong attention to detail and follow-up.
Ability to manage projects, assignments, and competing priorities.
Proficiency in 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 the activities of the Fiscal Intermediary’s Provider Enrollment Unit and enrollment and maintenance of more than 100 provider types and over 65,000 providers.
Monitor the Medicaid Provider Subsystem for continued compliance with federal and state regulations and legislative or independent audit findings.
Recommend criteria for closing and removing inactive 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 current program and system functions.
Communicate and meet with federal regulatory agencies, FI staff, providers, and program staff regarding program and system changes, enhancements, and integrity.
Attend meetings to coordinate implementation of policy changes affecting providers.
Participate in strategy development with the FI to formulate and implement changes.
Assist with development and implementation of the Provider Management Project and serve as the Provider Enrollment subject matter expert.
Monitor and assist the FI with day-to-day Provider Enrollment 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 developments, major changes, and issues.
Consult with internal staff and external agencies about Provider Enrollment issues and assist with procedures to maintain 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 Provider Enrollment statistics produced by the FI.
Monitor the FI’s compliance with its contractual obligations.
Perform other duties as assigned.