Provider Enrollment Specialist

Summary:

• Coordinates Medicare and Medicaid enrollment/re-enrollment, managed care credentialing, and provider contracting processes. Serves as the billing system administrator, assists practices with system issues, maintains NPI files and provider numbers, and acts as a customer service liaison. Monitors accounts receivable, reviews payments to maximize reimbursement, and collaborates with patients, insurance carriers, billing vendors, and practice personnel regarding patient accounts. Performs all duties professionally and courteously.

Key Responsibilities:

Provider Enrollment & Credentialing

• Collect and maintain provider data for Medicare and Medicaid enrollment.
• Prepare and submit applications for new provider enrollments and updates.
• Follow up with Medicare, Medicaid, and insurance carriers regarding application status via phone or written communication.
• Ensure compliance with Medicare and Medicaid provider enrollment guidelines.
• Request NPI numbers for providers and clinics as needed.
• Maintain and update NPI files.

Claims & Revenue Cycle Management

• Follow up with insurance companies and patients regarding outstanding claims and appeals.
• Generate reports to identify claim issues related to provider numbers and non-payment.
• Communicate claim-related information to appropriate personnel.
• Monitor accounts receivable and review payments to maximize reimbursement.
• Identify and resolve problem accounts through completion.
• Review Athena correspondence and unpostable claims.

Contract Management

• Collect and review managed care contracts to ensure accurate billing and payment terms.

Training & System Support

• Educate staff on billing corrections, including front-end entry errors, in a constructive manner.
• Participate in enrollment, credentialing, and billing system training sessions.
• Assist with Billing System software training as needed.
• Serve as the Billing System Superuser, providing support to clinics and answering user questions.

Compliance & Quality

• Follow CHRISTUS HIPAA guidelines to prevent unauthorized disclosure of Protected Health Information (PHI).
• Maintain strict confidentiality of sensitive information.
• Communicate effectively in a clear, professional, and positive manner consistent with the CHRISTUS Mission.
• Adhere to CHRISTUS policies, procedures, quality assurance, safety, environmental, and infection control standards.
• Perform responsibilities in accordance with the CHRISTUS Mission, Code of Ethics, and diversity objectives.
• Complete other related duties as assigned.

Requirements:

• High School Diploma.
• 1–3 years of payer enrollment experience.
• Proficiency in Microsoft Word, Excel, and Access.
• Excellent written and verbal communication skills.
• Strong organizational, planning, and teamwork abilities.
• Proven ability to work effectively with all levels of management and staff.