Provider Enrollment Specialist - Managed Care (Galveston)

Provider Enrollment Specialist

The Provider Enrollment Specialist is responsible for coordinating, monitoring and maintaining the provider enrollment and re-enrollment process in a timely and compliant manner with all government and commercial payors. Facilitates all aspects of provider enrollment, including initial enrollment, reenrollment, monitoring, and appointment for the medical staff and allied health practitioners.

Required Education & Experience

Minimum Qualifications:

• One year of financial, credentialing, billing, or related experience in a healthcare organization.

Preferred Qualifications:

• Associate's degree preferred
• 2 years of experience in a healthcare or medical setting preferred.

Essential Job Functions

• Facilitate enrollment of new UTMB providers to ensure proper and timely billing and collections.
• Prepare enrollment applications for all health plans including Medicare and Medicaid.
• Complete data entry and processing of enrollment applications, with validation of provider submitted information to ensure the application is complete, accurate, and meeting UTMB standards.
• Maintain timelines on enrollment processes, and address and/or escalate any delays.
• Ensure that all pending enrollments are reviewed, obtained and managed according to the rules and policies of the department.
• Provide monthly notification of new providers, resignations, and changes in provider status such as practice locations and panel status to contracted plans.
• Follow up with necessary contacts, including providers and managed care organizations, to resolve enrollment application issues and deficiencies.
• Demonstrate a level of competence and understanding of all state and federal laws, rules and regulations according to payer guidelines for billing.
• Respond to internal and external inquiries on routine enrollment and contract matters, as appropriate.
• Perform detailed follow-up activities on assigned accounts according to procedures.
• Assists in resolving outstanding AR accounts at a defined level of productivity.
• Maintain confidentiality of all provider enrollment business/work and medical staff information.

Marginal or Period Functions

• Prioritize and complete all work in an accurate, effective and efficient manner.
• Participate in team meetings/activities and support the philosophy and goals of the team and department.
• Participate in special projects/assignments.
• Read all announcements and relevant communications relating to job duties.
• Successfully complete competency based training and testing.
• Adheres to internal controls and reporting structure.
• Performs related duties as required.

Knowledge / Skills / Abilities

• Knowledge of insurance claim processing and third party reimbursement.
• Knowledge of state and federal regulations as they pertain to billing processes and procedures.
• Ability to understand and interpret statistical reports and perform quantitative analysis.
• Knowledge of the principles of Information Systems in order to effectively analyze and make decisions, preferably with experience in Epic and database management.
• Skill in effective oral, written, and interpersonal communication.
• Skill in time management and project management.
• Ability to work efficiently under pressure.
• Ability to operate a computer and related applications.
• Ability to work independently and take initiative.
• Ability to demonstrate a commitment to continuous learning and to operationalize that learning.
• Ability to deal effectively with constant changes and be a change agent.
• Ability to deal effectively with challenging situations.
• Ability to willingly accept responsibility and/or delegate responsibility.

Working Environment/Equipment

• Standard office environment and equipment.

Salary Range

Actual salary commensurate with experience.

Work Schedule

On-site position, Monday through Friday, 8:00 AM to 5:00 PM, and as needed on occasion.

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.