Provider Enrollment Representative

About the role

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.

Responsibilities

• 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.
• 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.
• 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.

Qualifications

• High school diploma or equivalent preferred.
• Previous experience as Billing Representative, Credentialing, or Provider Enrollment preferred.
• General computer skills, including the ability to use the range of Microsoft products required.

Pay

$19.00 - $30.50 per hour

Schedule

Full time, 40 hours per week, 8-hour day shifts

Benefits

• 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