Provider Enrollment Coordinator

University of Arkansas System•Little Rock, AR

18h

About The Position

The Provider Enrollment Coordinator provides support for the Provider Enrollment functions for UAMS Health professional providers. The Provider Enrollment Coordinators coordinate collection and maintenance of provider information and communicate/work with payer representatives to ensure that UAMS Health professional providers are enrolled with payers timely and accurately. The Provider Enrollment Coordinator must work closely & professionally with Credentialing (Professional/Medical Staff Offices) at UAMS & ACH hospitals; Credentialing/Contracting at CHCS PHO/ACCN), COM & Service Line administrators/staff, physicians and other licensed health care providers, governmental payers, insurance companies and internal teams including Professional Billing Services, Epic IT, Contracting & Finance to ensure professional providers are enrolled, contracted & credentialed with third party payers and that provider information is properly recorded to support correct and timely billing for professional services. The Provider Enrollment Coordinator will also provide detailed computing support in developing and managing reporting structures, tracking systems, automating any processes as possible, and for overall productivity and accuracy of the enrollment processes. The Provider Enrollment Coordinator has extensive and regular interactions with other departments, providers, third-party payers, and others. Decisions will have a direct impact upon the efficiency and effectiveness of enrollment & billing functions, and upon direct staff. Decisions also have the potential to affect Credentialing, COM departments and Contracting Services. Must function independently with a strong awareness of the interactions and interdependency of all areas. This position does not directly influence budget-making decisions; however, this person should possess the ability to understand the impact on the budget of decisions made from their unit.

Requirements

Bachelor’s degree OR high school diploma plus 4 years' experience in medical revenue cycle and/or credentialing/enrollment or an equivalent combination of education and experience.

Responsibilities

Review and recommend appropriate level of staff status for applicants and advise Department Business Administrators, Service Line Administrators and/or their designees.
Process provider enrollment packets for completion to send out to payers in a timely manner.
Prepare application & enrollment packets for distribution to professional providers. Maintain logging systems to ensure that all packets are returned.
Upon return of packets, review data for completeness.
Follow up to obtain missing information as needed. Review/discuss enrollment process with physicians / providers and/or department liaisons and/or leaders as necessary.
Maintain accurate professional provider data in enrollment/credentialing database.
Enroll physicians and other professional providers in the appropriate reimbursement programs and ensures that the billing office is able to bill/collect from these payers on a timely basis.
Coordinate with the hospital Professional/Medical Staff Offices (PSO / MSO) and/or PHOs where applicable for privileged providers to maintain consistent & accurate information regarding physician billing and license numbers.
Coordinate with the UAMS Health Contracting department as needed to ensure providers are appropriately enrolled and linked to managed care contracts.
Correspond with and contact third-party payers regarding enrollment activity, policies & procedures.
Assure that time sensitive verifications & expirables used in enrollment process are reviewed regularly and followed up on where needed.
Respond to provider and departmental questions timely and appropriately including Professional Billing, Access, Epic IT, and Finance to ensure provider data is correct and answer enrollment related questions.
Maintain professional competency and understanding of payer enrollment & credentialing requirements.
Review reappointment dates for ACH & not privileged providers and insure that all provider reappointments are compliant with Departmental Policies and procedures.
Adhere to Departmental confidentiality standards.
Cross train within the Department to support Out of State Medicaid Enrollment, Payer enrollment, and other administrative functions as needed.
Maintain productive work relationships with all internal and external contacts including Physicians, Allied Health Professionals, Department Business Managers, Service Line Administrators, and designated contact person and Medical Staff leadership.
Participate in continuing education programs offered by the System and external programs as appropriate
Accurately enter data into the credentialing/enrollment database.
Assure that all information in the credentialing/enrollment databases is current, complete and accurate.
Provide reports as scheduled and requested.
Maintain accurate records of the status of all applications at all times.
Maintain claim eligibility table in Epic and processes enrollment issues located in Epic work queues.