Provider Enrollment Specialist

PHI - Quality Care Through Quality Jobs•Phoenix, AZ

1d•Onsite

About The Position

PHI Health is seeking dynamic and driven individuals to join their team as Provider Enrollment Specialists. This role is crucial for ensuring the prompt and accurate payment of submitted claims by managing provider enrollment, electronic data interchange (EDI), electronic funds transfer (EFT), electronic remittance advice (ERA), and payer web portal requirements with governmental and commercial payers. The specialist will develop in-depth knowledge of payer policies and regulations, navigate various payer systems, and serve as the initial contact for troubleshooting and process improvements related to government payers. This position requires strong communication and interpersonal skills, outstanding attention to detail, and the ability to independently prioritize and manage a high volume of work in a fast-paced environment. The role involves collaborating with multiple departments, including Patient Financial Services, GE Billing Services, Operational and Compliance leadership, to facilitate revenue flow and ensure compliance. A high level of awareness of the organizational structure of PHI Group, Inc., PHI Corporate, LLC, and PHI Health, LLC is necessary to ensure accurate representation on applications. The specialist will also be responsible for developing and maintaining a database of EMS licenses, conducting audits, and training others on payer and regulatory requirements. Maintaining confidentiality and adhering to company policies and procedures are paramount. This position is designated as Safety Sensitive.

Requirements

High school diploma or GED equivalent required.
Previous provider enrollment experience required.
Knowledge of general office procedures and using office equipment.
Demonstrated expertise in MS Office suite software.
Outstanding attention to detail skills.
Strong communication and interpersonal relationship development skills.
Ability to independently prioritize and process a high volume of work.
High level of awareness of PHI Group, Inc., PHI Corporate, LLC and PHI Health, LLC organizational structure.
Excellent communication skills to train on the complexities of payer and regulatory requirements.
Possess the ability to initiate and follow through on detailed regulatory requirements.
Complying with Company HS&E policy and procedures.
Responsible for supporting company Safety Management Systems activities.
Understand and provide visible support of Destination Zero.

Nice To Haves

Experience with electronic data interchange (EDI), electronic funds transfer (EFT), electronic remittance advice (ERA), and payer web portals.
Familiarity with government payers such as Medicare, Medicaid, and Tricare.
Experience in the air medical industry or emergency medical services.

Responsibilities

Develop, coordinate, implement, and manage provider enrollment (PE), electronic data interchange (EDI), electronic funds transfer (EFT), electronic remittance advice (ERA), and payer web portal requirements with governmental and commercial payers.
Obtain appropriate signatures and verify application accuracy prior to submission.
Develop in-depth knowledge of payer policies, regulations, requirements, and necessary forms for multiple states.
Navigate myriad payer systems to understand specific process requirements and utilize on-line tools for managing enrollments, electronic claims status, remittances, payments, and clearinghouse activities.
Serve as the initial contact for troubleshooting, monitoring document transmissions, and identifying opportunities for process improvements regarding government payers.
Communicate and work closely with Patient Financial Services, Cash Posting, GE Billing Services, Operational and Compliance leadership, and provide technical support to facilitate prompt revenue flow in a compliant manner.
Independently prioritize and process a high volume of work.
Identify and develop workflow processes to meet ever-changing regulatory requirements.
Request and organize supporting documentation from multiple departments for provider enrollment applications.
Develop and maintain a database of all EMS licenses for all base locations to assure consistency with submitted documentation.
Identify, develop, and conduct audits of and for Provider Enrollment and Patient Financial Services.
Train on the complexities of payer and regulatory requirements.
Communicate to management all changes in Medicare/Medicaid/Tricare/HIS and all other federal payer enrollment requirements.
Maintain the highest level of confidentiality at all times in accordance with HIPAA guidelines and PHI Group Inc. and PHI Health, LLC policies.
Adhere to all PHI Group, Inc. and PHI Health, LLC policies and procedures.
Demonstrate responsiveness and a sense of urgency when dealing with payers and internal customers.
Initiate and follow through on detailed regulatory requirements.
Comply with Company HS&E policy and procedures.
Support company Safety Management Systems activities.
Provide visible support of Destination Zero.
Perform other duties as assigned.