Provider Enrollment Specialist

Job Description

Job Description

• Collects and maintains data on providers for Medicare and Medicaid enrollment
• Prepares and submits applications to Medicare and Medicaid for new provider enrollments and existing provider updates; follows up by telephone or in writing with carriers regarding application status
• Complies with Medicare and Medicaid provider enrollment guidelines
• Requests NPI numbers for providers and clinics as necessary and maintains NPI files
• Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and/or appeals
• Generates various reports to identify outstanding claims issues with provider numbers and non-payment
• Communicates information to appropriate personnel
• Educates staff on corrections (e.g., front-end entry errors) in a positive, constructive manner
• Collects and reviews managed care contracts for correct billing and payment terms
• Identifies problem accounts and follows through to completion
• Reviews Athena correspondence and unpostables
• Participates in company-sponsored enrollment/credentialing meetings and other educational activities
• Participates in Billing System Training exercises and updates
• Assists in training on the Billing System software package when necessary
• Serves as a Superuser of the Billing System to be available to answer questions from the various clinics
• Follows guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
• Maintains strict confidentiality
• Uses oral and written communication skills to effectively convey ideas in a clear, positive manner
• Maintains established policies, procedures, objectives, quality assurance, safety, environmental, and infection control standards
• Implements job responsibilities in a manner consistent with organizational mission, code of ethics, and cultural diversity objectives
• Performs other related work as required