PROVIDER ENROLLMENT SPECIALIST

Fort Defiance Indian Hospital Board, Inc.•Fort Defiance Agency, AZ

22h•$24 - $29

About The Position

This position ensures accurate and timely enrollment for health care providers, physicians, and mid-level practitioners. The specialist coordinates with other credentialing staff and the Director of Revenue Generation to obtain essential information for the enrollment process. They manage the distribution of enrollment forms and packets, respond to inquiries, and submit new provider enrollment applications through electronic portals. The role involves tracking online applications, assisting with updates and modifications for existing providers, and ensuring accurate linking to the correct facility. A key responsibility is submitting Medicare revalidations and provider contract requests to payers like Blue Cross Blue Shield (BCBS) and Tricare. The specialist communicates with internal and external credentialing staff regarding deficiencies, follows up on outstanding documents, and maintains electronic records for audits. They are responsible for meeting deadlines, managing enrollment schedules, assisting providers with CAQH profiles, and completing provider turnaround documents for New Mexico Medicaid. Additionally, they notify payers of exiting provider end dates and maintain a comprehensive provider listing for management, including NPI information, department, title, licensure details, and payer-assigned numbers. A weekly productivity summary report is also required.

Requirements

Two (2) years enrollment experience or two (2) years Revenue Cycle Management experience in a healthcare environment
Associate Degree or equivalent experience
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.
Provide a weekly productivity summary report to direct supervisor.
Performs other duties as assigned.