Provider Enrollment Specialist

Job Summary

The Provider Enrollment Specialist works in conjunction with the Provider Enrollment Manager to identify Provider Payer Enrollment issues or denials. This position is responsible for researching, resolving, and enrolling any payer issues, utilizing a variety of proprietary and external tools.

This will require contacting clients, operations personnel, and Centers for Medicare & Medicaid Services (CMS) via phone, email, or website.

Essential Functions And Tasks

• Performs follow-up with market locations to research and resolve payer enrollment issues.
• Performs follow-up with Centers for Medicare & Medicaid Services (CMS), and other payer via phone, email or website to resolve any Payer Enrollment issues.
• Manages the completion and submission of CMS Medicare, State Medicaid and any other third-party payer applications.
• Tracks and follows up to ensure provider numbers are established and linked to the appropriate client group entity and proper software systems.
• Maintains documentation and reporting regarding payer enrollments in process. Retains records related to completed CMS applications.
• Maintains close working relationships with Clients, Operations, and Revenue Cycle Management team.
• Proactively obtains, tracks, and manages all payer revalidation dates for all assigned groups/providers as well as complete, submit, and track the required applications to maintain active enrollment and prevent deactivation.
• Adds providers to all applicable systems and maintains information to ensure claims are held/released based on status of enrollment.
• Performs special projects and other duties as assigned.

Education And Experience Requirements

• Associate's degree (2 years), required and Bachelor's degree in any related field, preferred.
• At least one (1) year of provider enrollment experience preferred.

Knowledge, Skills, And Abilities

• Working knowledge of specific application requirements for Centers for Medicare & Medicaid Services (CMS), State Medicaid and all third-party payers including pre-requisites, forms required, form completion requirements, supporting documentation such as Drug Enforcement Agency Number (DEA), Curriculum Vitae (CV), and regulations.
• Working knowledge of physician HIPAA Privacy & Security policies and procedures.
• Strong oral, written, and interpersonal communication skills.
• Strong word processing, spreadsheet, database, and presentation software skills.
• Strong detail orientation skills.
• Strong analytical skills.
• Strong decision-making skills.
• Strong problem-solving skills.
• Strong organizational skills.
• Strong time management skills.
• Ability to ensure the complex enrollment packages are complete and correct.
• Ability to work cohesively in a team-oriented environment.
• Ability to foster good working relationships with others both within and outside the organization.
• Ability to work independently and require little supervision, to focus on and accomplish tasks.
• Ability to maintain strict confidentiality with regards to protected provider and health information.
• Ability to take initiative and effectively troubleshoot while focusing on innovative solutions.
• Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately.
• Ability to remain flexible and work within a collaborative and fast-paced environment.
• Ability to communicate with diverse personalities in a tactful, mature, and professional manner.

Compensation

Base compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons. This position is also eligible for a discretionary incentive bonus in accordance with company policies.

Ventra Health Equal Employment Opportunity

Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status.

Solicitation of Payment

Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes. Solicitation of payment from any source is strictly prohibited.

Attention Candidates

Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities Ventra Health Private Limited and Ventra Health Global Services. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters. To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at Careers@VentraHealth.com to confirm the legitimacy of the offer and the person who contacted you.

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