Provider Enrollment Specialist II

Easterseals MORC•Auburn Hills, MI

About The Position

This role is responsible for facilitating the enrollment of new providers to ensure proper and timely billing and collections. The specialist will prepare and process enrollment applications for various health plans, including Medicare and Medicaid, ensuring accuracy and adherence to standards. Key duties include obtaining and maintaining necessary provider documentation, managing enrollment timelines, resolving application issues, and communicating provider status changes to contracted plans. The position also involves following up on provider-related denials, understanding relevant state and federal laws, and responding to inquiries regarding enrollment and credentialing. Additionally, the specialist will maintain records of provider participation, re-credential providers as needed, and manage electronic storage of provider documents.

Requirements

Competence and understanding of all state and federal laws, rules and regulations according to payer guidelines for billing.

Responsibilities

Facilitate enrollment of new Easterseals MORC providers to ensure proper and timely billing and collections.
Prepare enrollment applications for all health plans including Medicare and Medicaid.
Complete data entry and processing of enrollment applications, with validation of provider submitted information to ensure the application is complete, accurate, and meeting Easterseals MORC standards.
Obtain licensure, certification and insurance certificates at time of enrollment and maintain in database in order to submit with enrollment applications.
Maintain timelines on enrollment processes, and address and/or escalate any delays.
Ensure that all pending enrollments are reviewed, obtained and managed according to the rules and policies of the department.
Provide monthly notification of new providers, resignations, and changes in provider status such as practice locations and panel status to contracted plans.
Follow up with necessary contacts, including providers and managed care organizations, to resolve enrollment application issues and deficiencies.
Facilitate resolution of provider related denials to ensure appeal procedures are followed to result in proper reimbursement.
Demonstrate a level of competence and understanding of all state and federal laws, rules and regulations according to payer guidelines for billing.
Respond to internal and external inquiries on routine enrollment and contract matters, as appropriate.
Perform detailed follow-up activities on assigned accounts according to procedures.
Resolve outstanding AR accounts at a defined level of productivity.
Maintain confidentiality of all provider enrollment business/work and medical staff information.
Identifies issues requiring additional investigation and evaluation; validate discrepancies and ensure appropriate follow up.
Retains detailed and accurate lists of insurance plans in which providers participate and their effective dates with each plan.
Responds to inquiries from payer organizations regarding credentialing and privileging issues as they arise.
Performs follow up with insurance plans to resolve provider enrollment issues and obtain provider participation status.
Communicates with providers and staff members regarding each provider’s participation status in insurance plans.
Sends updated list of providers and their effective status with insurance plans regularly to staff as needed.
Notifies insurance plan representatives of a provider’s change in status or when a provider leaves agency.
Re-credentials providers as required by individual insurance plans.
Scans provider documents and store electronically in provider database.
Performs other duties as assigned.