Provider Enrollment Specialist

FDIHB•Fort Defiance, AZ

2d•Onsite

About The Position

This role is responsible for ensuring the accurate and timely enrollment of healthcare providers, physicians, and mid-level practitioners. The specialist will coordinate with credentialing and revenue generation teams to gather necessary information, manage provider inquiries, and submit enrollment applications through various online portals. A key aspect of the role involves tracking applications through all stages to ensure proper enrollment with commercial, Medicare, and State Medicaid payers. The position also handles updates and modifications to existing provider enrollments, maintains effective processes for monitoring enrollment status, and assists with Medicare revalidations and provider contract requests. Communication with internal and external credentialing staff, follow-up on outstanding documents, and maintaining electronic records for audits are crucial. The specialist will manage deadlines, track files, assist with CAQH profiles, complete provider turnaround documents, and notify payers of exiting providers. Additionally, the role involves maintaining a provider listing with detailed information and submitting weekly productivity reports.

Requirements

Two (2) years enrollment experience or two (2) years Revenue Cycle Management experience in a healthcare environment
Associate Degree or equivalent experience
A valid, unrestricted insurable driver’s license
Resumes and references are required

Responsibilities

Ensures accurate and timely enrollment for health care providers, physicians and mid-level practitioners.
Coordinates with other credentialing and Director of Revenue Generation on obtaining essential information to complete the enrollment process.
Coordinates and ensures providers receive enrollment forms and packets where applicable, responds to all inquiries regarding enrollment using timely and effective communication with providers, programs, and other credentialing staff.
Submits new provider enrollment applications via electronic online provider enrollment portals and will track online applications through all stages in order to accurately enroll each provider with commercial, Medicare and State Medicaid payers.
Assist with updates and/or modifies provider enrollment for current and returning providers with Medicare and State Medicaid plans, to ensure that all billable providers are appropriately linked to the correct facility.
Maintains and recognizes effective processes for monitoring provider enrollment status for all commercial, Medicare and State Medicaid health plans.
Reviews and submits accurate enrollment applications.
Assists with submitting Medicare revalidations for Facility in a timely manner with Medicare to avoid loss of billing privileges.
Submits the Provider Contract Request Form along with other required documentation to Blue Cross Blue Shield (BCBS) and Tricare payers for all medical providers, this is to ensure linking of medical providers to the Fort Defiance Indian Hospital Board, Inc. Facility NPIs.
Communicates with other internal and/or external credentialing staff and supervisors on any deficiencies.
Follows up on all submitted and outstanding documents for providers.
Obtains all applications and supporting documents for State Medicaid, Medicare, and commercial plans from providers and keep on file electronically for audits purposes.
Maintain deadlines and enrollment schedules by tracking files through all stages of the enrollment process.
Assists provider’s with completing and updating of their Council for Affordable Quality Healthcare (CAQH) profiles.
Completes the provider turnaround document (TAD) to New Mexico Medicaid, by deadlines scheduled by payers.
Notifies Medicare and State Medicaid Plans of the appropriate end date for exiting medical providers within 1 (one) year after departure.
Responsible for providing and updating a provider listing to the Director of Revenue Generation, which consists of provider NPI information, department, title, state licensure, expiration dates, start date, and payers assigned provider numbers for active, consulting, and inactive providers.
In addition, to provide a weekly productivity summary report to direct supervisor.
Performs other duties as assigned.