Provider Enrollment Specialist

EnableComp • Franklin, TN

2d

About The Position

The Provider Enrollment Specialist, Medicaid, has primary responsibility for oversight and maintenance of the professional and facility enrollment process. This will include submission of both online and paper applications. This position is responsible for handling patient health information (PHI) and maintaining extreme privacy and security as it relates to confidential and proprietary information.

Requirements

• High School Diploma or GED required. Associates or Bachelor’s Degree preferred.
• 1+ years’ experience in healthcare field working in billing or collections.
• 1+ years’ client facing/customer services experience.
• Intermediate level understanding of insurance payer/provider claims processing and subsequent data requirements.
• Thorough understanding of the enrollment requirements and documents needed for the accurate completion of applications
• Knowledge of general credentials and licenses is preferred but not required: hospital license, CLIA, DEA, NPI, board certifications, etc.
• Equivalent combination of education and experience will be considered.
• Must have strong computer proficiency and understand how to use basic office applications, including MS Office (Word, Excel, and Outlook).
• Regular and predictable attendance.
• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Nice To Haves

• Knowledge of general credentials and licenses is preferred but not required: hospital license, CLIA, DEA, NPI, board certifications, etc.

Responsibilities

• Collect, verify, and submit information necessary for the enrollment of hospitals/physicians with Out-of-State Medicaid payers.
• Develop and maintain ongoing policy and procedures specific to each state for new hospital/physician enrollments.
• Maintain working knowledge of hospital/physician Out-of-State Medicaid enrollment requirements and regulations. Ensure appropriate education and communication is shared with internal team members, including the Vice President and Senior Vice President of Operations.
• Submits re-enrollment applications in a timely manner to ensure hospitals/physicians are up to date with their enrollment status.
• Establish, maintain, and constantly review the accuracy of Out-of-State Medicaid requirements to ensure compliance with government rules and regulations.
• Manage work queue to ensure all timely submissions/deadlines of all payor-specific forms and documents to the various health plans including license updates, deficiency notifications, approval letters, etc.
• All maintenance of the provider file and communication of provider changes, corrections, and terminations documented in the database.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED