Posted: Sunday, March 5, 2017 12:20 AM
Enrollment Specialists will support the division in facilitating the enrollment (submitting of applications) of the providers with the various government and insurance healthcare payors, network managed care contracting negotiations, and third:party billing entities that require provider enrollment. They are responsible for the accounts receivable on hold pending provider number assignment by the payors.
Essential Duties and Responsibilities:
:Following established enrollment procedures and sound practice directly, prepares applications for all new providers for multiple contracts sites, payors and states requiring an acute attention to detail, accuracy and knowledge of complex and varied requirements. Review applications for completeness, flag missing information and signatures before sending the pre:populated applications to the providers for completion. Track and follow up on a timely basis to ensure completion of application process and submission to payor for approval.
:Coordinates the maintenance of the division contract database; tracks new contracts through the review and approval process
:Ensures divisional personnel have access to information for managing divisional contracting activities; including, provider onboarding, RCM processing, and release / refile of held A/R.
:Supports the divisions private healthcare payor contract effort by performing ad hoc contract negotiations, reviewing contract language, maintaining the practice management operations software, managed care contracting lists, and facilitating communication among the division and private healthcare payors.
:Extensive and frequent verbal and written communications with Clinicians, state payors, insurance carriers, third party billing company and internal company staff requiring professionalism and tact to attain or provide all needed information quickly in order to expedite the enrollment of Clinicians in the various plans to maximize billing opportunities. Acts proactively and builds strong relationships with payors to facilitate enrollment and obtain provider billing numbers.
:Utilizes templates or prepares correspondence inserting proper provider and group related information for submission of applications to payors. Anticipate payor needs, proactively address and resolve issues with payors to ensure prompt approval of applications.
:Works with in:house and third party Billing Company for current applications, system updates and identifying/resolving problems. Handles corrections or rejections of claims due to enrollment errors and/or claim submission requirements. Conveys issues and status of problems to Enrollment Management. Ensures Held A/R enrollments are submitted on timely basis to avoid risk of claims/adjustments and an unnecessary increase of Held AR. Maintain and work reports of non:compliant providers and held A/R to maximize income opportunities.
:Accountable for meeting or exceeding divisional and/or corporate Enrollment performance standards and meeting time:sensitive deadlines as defined. Update status of application in system data bases and in excel reports for accurate reporting.
:Works independently within the scope of responsibility and authority. Understands and follows state and payor requirements, some of which are quite complex, and determines which applications require management approval or special processing requirements. Able to work with high volume enrollments while multi:tasking and driving provider enrollments through completion. (example: 10 contracts with 40 providers per contract)
:Adheres to all company policies and procedures.
Non:Essential Duties and Responsibilities:
:Perform other duties as assigned.
:Bachelors degree preferred or related experience
:Two years previous enrollment or related experience preferred
• Location: Dallas
• Post ID: 48648032 dallas