Provider Enrollment Specialist

Description The Provider Enrollment Analyst (I) is responsible for coordinating the provider enrollment and payer credentialing efforts for contracted FPA providers with Medicare and Medicaid. This individual manages all open provider enrollment tasks/ issues to ensure that providers are reimbursed for services provided and billed, and performs data analysis and special projects as assigned. Responsibilities Enrolls and terminates providers with CMS and other government programs by completing 855 series forms, gathers credentials and associated documentation required for enrollment and process enrollment forms. Tracks status of "in process" enrollment forms until final approval received. Files provider ID numbers once assigned by governing agencies and performs system updates as appropriate. Responsible for the initial setup of new groups and providers for 837P and 835P EDI transactions as well as EFT. Monitors TES edits, BAR edits, eCommerce edits, and payer denials for issues related to enrollment, and follow-up on claims until resolved. Participates in CBO rebilling efforts due to provider enrollment issues. Communicates with providers and other departments to escalate issues, share information and promote the process of obtaining documentation required for enrollment. Assists department administrators and providers in performing online PECOS enrollment. Assists in the Revalidation letter process, downloading list from CMS, obtaining comparison reports from the Medicare Provider Enrollment Database and scheduling providers for online re-enrollment. Utilizes the reports within the Medicare Provider Database to monitor updates, promptly complete work orders and identify work to be completed. May assist in special projects, generates metrics, and provides reconciliations, research, and analyses as directed by Management. Assists management with Meaningful Use and PQRI tracking and reporting. Supports activities related to internal and external audits of providers and/or departments. Responds to inquiries and provide information as requested. Performs other related duties as assigned. Qualifications Two years minimum of healthcare experience including Medicare or Medicaid Provider or Facility Enrollment or Credentialing experience required, including one year of revenue cycle-specific as well as direct customer service. Employer Description Strength through Unity and Inclusion The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai’s unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual. At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history. About the Mount Sinai Health System: Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally. Equal Opportunity Employer The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization. Compensation The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $28.1279 - $37.0609 Hourly. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits. #J-18808-Ljbffr