Provider Enrollment Representative

Facility: Remote MI (Central Time) • Location: Remote, MI • Shift: 8 Hours - Day • Full time • Weekly Hours: 40.00

Job Summary

Responsible for ensuring the timely enrollment of new providers with payors as well as new facility sites. Responsible for the on-going maintenance of existing providers and facility sites including re-enrollment and maintaining terminations. Monitor and maintain the process of gathering current, accurate, and complete information for provider directories and payor databases in compliance with regulations and payor requirements. Follow up with payors to obtain effective dates, status updates, and identification numbers for billing purposes. Update and maintain provider numbers and related data in both internal and external billing software and production programs. Maintain supporting documentation such as a W-9, CLIA certificate, bank, IRS, and CMS letters as applicable. Apply for or provide assistance with the application process for individual practitioner and/or facility national provider identifier (NPI) via national plan and provider enumeration system (NPPES). Notify payors and internal contacts of practitioner practice changes, including terminations, cases of malpractice, or other legal matters. Also will notify payors of site notification for payors (i.e., for new sites, site terminations, and changes). Perform account follow up on enrollment related denials and take the necessary action for account resolution in accordance with established federal and state regulations. Respond to internal and external inquiries regarding research issues. Review charges and claims pending report and/or claim edit work queues in Epic. May work Epic follow-up work queues to resolve enrollment-related issues. Keep current regarding any changes in managed care and other payor requirements for provider enrollment. Complete work within authorized time to assure compliance with strict departmental and compliance standards as well as payor time limits. Initiate enrollment for electronic claims submission. Attend site-planning meetings to provide input, gather necessary information for set up, and provide updates.

Responsibilities

• Ensure timely enrollment of new providers and facility sites with payors.
• Maintain existing providers and facility sites, including re-enrollment and terminations.
• Gather and maintain accurate information for provider directories and payor databases in compliance with regulations.
• Follow up with payors for effective dates, status updates, and identification numbers for billing.
• Update and maintain provider numbers and related data in billing software and production programs.
• Maintain supporting documentation (e.g., W-9, CLIA certificate, bank, IRS, and CMS letters).
• Assist with the application process for individual practitioner and/or facility NPI via NPPES.
• Notify payors and internal contacts of practitioner practice changes (e.g., terminations, malpractice, legal matters).
• Notify payors of site changes (e.g., new sites, terminations).
• Perform account follow-up on enrollment-related denials and resolve issues per federal/state regulations.
• Respond to internal and external inquiries regarding research issues.
• Review charges, claims pending reports, and claim edit work queues in Epic.
• Work Epic follow-up work queues to resolve enrollment-related issues.
• Stay current on managed care and payor requirements for provider enrollment.
• Complete work within authorized timeframes to comply with departmental and payor standards.
• Initiate enrollment for electronic claims submission.
• Attend site-planning meetings to provide input and gather setup information.

Qualifications

• High school diploma or equivalent preferred.
• Previous experience as a Billing Representative, Credentialing, or Provider Enrollment preferred.
• General computer skills, including proficiency with Microsoft products.

Pay

Salary Range: $19.00 - $30.50 per hour

Benefits

Sanford offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, benefits may include:

• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• 401(k) retirement plan
• Work/life balance benefits
• Generous time off package to maintain a healthy home-work balance

For more information about Total Rewards, visit sanfordcareers.com/benefits.