Provider Enrollment Coordinator (Hybrid - Dallas)

Integrative Emergency Services • Dallas, TX

8d • Hybrid

About The Position

Integrative Emergency Services, LLC ("IES") is looking for a Provider Enrollment Coordinator to support the division in facilitating the enrollment (payer applications) of both the Provider Groups and individual providers with the various government and commercial health insurance plans, network managed care contracting plans, and third-party billing entities that require provider enrollment. This includes CAQH maintenance. This position is also responsible for the AR on hold, pending provider number assignment, from the payers. Role will be Hybrid format 3 days in office at 4835 LBJ Fwy, Dallas, TX, 75244.

Requirements

• High School Diploma
• 2+ years payer enrollment (individual provider and group enrollment) or related experience
• Ability to obtain, set-up, maintain, and reattest CAQH profiles
• Prior government healthcare payer experience
• Excellent analytical, organizational, and verbal/written communication skills.
• Strong telephone skills.
• Ability to manage multiple priorities with high attention to detail within a high volume fast paced environment
• Strong customer service orientation
• Ability to use discretion appropriately and maintain confidentiality
• High levels of proficiency with MS Office applications, especially Microsoft Word and Excel
• Ability to read, write and speak English proficiently

Nice To Haves

• Bachelor’s degree
• Enrollment experience with both Commercial and Government Plans
• Multi-state Enrollment Experience

Responsibilities

• Completes CAQH applications for new and existing providers. Will maintain CAQH reporting and attest provider applications every 120 days.
• Following established enrollment procedures and sound practices directly or by working with Enrollment Coordinators.
• Prepares applications for new providers for multiple contracts sites, payers, and states requiring an acute attention to detail, accuracy and knowledge of complex and varied requirements.
• Submit applications electronically to payers based on contracts. Track and follow up on a timely basis to ensure completion of application process and submission to payer for approval.
• Extensive and frequent verbal and written communications with Clinicians, state payers, insurance carriers, third party billing company and internal company staff requiring professionalism and tact to attain or provide all needed information quickly in order to expedite the enrollment of Clinicians in the various plans to maximize billing opportunities.
• Acts proactively and builds strong relationships with payors to facilitate enrollment and obtain provider billing numbers.
• Utilizes templates or prepares correspondence inserting proper provider and group related information for submission of applications to payers.
• Works with in-house and third-party Billing Company for current applications, system updates and identifying/resolving problems. Handles corrections or rejections of claims due to enrollment errors and/or claim submission requirements.
• Conveys issues and status of problems to Enrollment Manager.
• Ensures Held A/R enrollments are submitted on timely basis to avoid risk of claims/adjustments and an unnecessary increase of Held AR. Maintain and work reports of held A/R to maximize income opportunities.
• Accountable for meeting or exceeding divisional and/or corporate Enrollment performance standards and meeting time-sensitive deadlines as defined.
• Update status of application in system databases and in excel reports for accurate reporting.
• Works independently within the scope of responsibility and authority. Understands and follows state and payer requirements, some of which are quite complex, and determines which applications require management approval or special processing requirements.
• Able to work with high volume enrollments while multi-tasking and driving provider enrollments through completion.
• Assist and maintain enrollment reporting for different payers including Superior Health, Healthscope, and Cigna.
• Will work and assist with the Enrollment Master Reports and track application submissions, re-validations and re-enrollment for all providers and groups.
• Adheres to all company policies and procedures.

Benefits

• Equal employment opportunities to qualified individuals with disabilities.
• Commitment to creating a diverse, inclusive, and equitable environment.
• Equal consideration for positions regardless of age, race, religion, nationality, sexual orientation, gender identity or expression, disability, or veteran status.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED