Provider Enrollment Specialist II-HP Enrollment Eligibility

Christus Health•Irving, TX

46d

About The Position

Coordinates Medicare and Medicaid enrollment/re-enrollment and managed care credentialing and contracting processes for providers. Serves as administrator for the billing system and assists practices with system issues. Maintains NPI files and provider numbers. Serves as customer service liaison. Monitors accounts receivable to maintain appropriate levels and reviews payments to maximize reimbursement. Interacts with patients, insurance carriers, the billing vendor, and practice personnel concerning patient accounts. Performs all functions in a courteous and professional manner.

Requirements

High School Diploma
1-3 years of Payer Enrollment experience
Solid knowledge and utilization of PC applications to include WORD, EXCEL, ACCESS
Excellent written and verbal communication skills
Excellent organization and planning skills with demonstrated teamwork skills
Proven ability to interact with all levels of management and other Associates

Responsibilities

Collects and maintains data on providers for Medicare and Medicaid enrollment
Prepares and submits applications to Medicare and Medicaid for new provider enrollments and existing provider updates; follows up by telephone or in writing, with carriers regarding application status
Complies with Medicare and Medicaid provider enrollment guidelines
Requests NPI numbers for providers and clinics as necessary and maintains NPI files
Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and/or appeals
Generates various reports to identify outstanding claims issues with provider numbers and non-payment
Communicates information to appropriate personnel
Educates staff on corrections, e.g.. front-end entry errors in a positive, constructive manner
Collects and reviews managed care contracts for correct billing and payment terms
Identifies problem accounts and follows through to completion
Reviews Athena correspondence and unpostables
Participates in company sponsored enrollment/credentialing meetings and other educational activities
Participates in Billing System Training exercises and updates
Assists in training on the Billing System software package when necessary
Serves as a Superuser of the Billing System to be available to answer questions from the various clinics
Follows the CHRISTUS guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
Maintains strict confidentiality
Uses oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with the CHRISTUS Mission
Maintains established CHRISTUS policies, procedures, objectives, quality assurance, safety, environmental and infection control
Implements job responsibilities in a manner that is consistent with the CHRISTUS Mission and Code of Ethics and supportive of CHRISTUS Physician Group's cultural diversity objectives
Performs other related work as required