Provider Enrollment Representative

Sanford Health•Time, IL

3d•$19 - $31•Onsite

About The Position

Responsible for ensuring the timely enrollment of new providers with payors as well as new facility sites. Responsible for the on-going maintenance of existing providers and facility sites including re-enrollment and maintaining terminations. Monitor and maintain the process of gathering current, accurate, and complete information for provider directories and payor databases in compliance with regulations and payor requirements. Follow up with payors to obtain effective dates, status updates, and identification numbers for billing purposes. Update and maintain provider numbers and related data in both internal and external billing software and production programs. Maintain supporting documentation such as a W-9, CLIA certificate, bank, IRS, and CMS letters as applicable. Apply for or provide assistance with the application process for individual practitioner and/or facility national provider identifier (NPI) via national plan and provider enumeration system (NPPES). Notify payors and internal contacts of practitioner practice changes, including terminations, cases of malpractice, or other legal matters. Also will notify payors of site notification for payors (i.e., for new sites, site terminations, and changes). Perform account follow up on enrollment related denials and take the necessary action for account resolution in accordance with established federal and state regulations. Respond to internal and external inquiries regarding research issues. Review charges and claims pending report and/or claim edit work queues in Epic. May work Epic follow-up work queues to resolve enrollment-related issues. Keep current regarding any changes in managed care and other payor requirements for provider enrollment. Complete work within authorized time to assure compliance with strict departmental and compliance standards as well as payor time limits. Initiate enrollment for electronic claims submission. Attend site-planning meetings to provide input, gather necessary information for set up, and provide updates.

Requirements

High school diploma or equivalent preferred.
Previous experience as Billing Representative, Credentialing, or Provider Enrollment preferred.
General computer skills, including the ability to use the range of Microsoft products required.

Responsibilities

Ensuring the timely enrollment of new providers with payors and new facility sites.
On-going maintenance of existing providers and facility sites, including re-enrollment and maintaining terminations.
Monitoring and maintaining the process of gathering current, accurate, and complete information for provider directories and payor databases.
Following up with payors to obtain effective dates, status updates, and identification numbers for billing purposes.
Updating and maintaining provider numbers and related data in internal and external billing software and production programs.
Maintaining supporting documentation such as a W-9, CLIA certificate, bank, IRS, and CMS letters.
Applying for or providing assistance with the application process for individual practitioner and/or facility national provider identifier (NPI).
Notifying payors and internal contacts of practitioner practice changes, including terminations, malpractice, or other legal matters.
Notifying payors of site notification for payors (new sites, site terminations, and changes).
Performing account follow-up on enrollment-related denials and taking necessary action for account resolution.
Responding to internal and external inquiries regarding research issues.
Reviewing charges and claims pending reports and/or claim edit work queues in Epic.
Working Epic follow-up work queues to resolve enrollment-related issues.
Keeping current regarding changes in managed care and other payor requirements for provider enrollment.
Completing work within authorized time to assure compliance with departmental, compliance, and payor standards.
Initiating enrollment for electronic claims submission.
Attending site-planning meetings to provide input, gather information, and provide updates.