Provider Enrollment Specialist - Full time - Detroit

General Summary

Under general supervision, responsible for all functions relating to ensuring that all appropriate practitioners are enrolled in government programs and commercial health plans. Primary responsibilities include taking a new provider application from receipt to inclusion in directory and making ongoing updates.

Principal Duties and Responsibilities

· Responsible for comprehensive and precise data entry for maintaining the accuracy of the enrollment database. · Responsible for following department database standards for the documentation of all health plans and products, documents, and notes on incoming and outgoing attempts to obtain information and follow up conversations. · In depth working knowledge of various payor applications associated with the workflow process, i.e., Webdenis, CHAMPS, PECOS, CAQH. · Follows the Network Management workflow process in real time meeting required turnaround times and accuracy rates. · Verifies all required information and obtains necessary documents to ensure providers are processed according to current policies and procedure and ensure all files have a welcome, denial, or term letter, as appropriate. · Facilitates research and resolves denied claims & enrollment issues. · Possesses in depth knowledge of health plan standards and department operating procedures and effectively communicates issues, trends, concerns among team members and interdepartmental customers. · Communicates with internal and external customers in a clear, concise and professional manner to obtain or provide necessary information. · Organize and maintain practitioner files following confidentiality guidelines. · Participates in system integration and continuing quality improvement efforts. · Provides support and problem solving to Department Director in the development of short and long-range plans for the department, assuring overall continuity of the corporate strategic.

Educational/Experience Required

• High School Diploma required. Associate’s Degree preferred. • 2-5 years of provider enrollment provider billing or credentialing experience required. • High level of energy to work in a fast paced constantly changing environment often including time deadlines, frequent interruptions, multiple demands and multi-tasking. • Ability to work under minimal supervision. • Ability to perform detail work efficiently and with a high degree of accuracy. • High organized. • Strong business acumen. • Excellent verbal and written communication skills. • Ability to interpret information and make judgments quickly. • Ability to interact professionally with practitioners and other external customers Strong quantitative and analytical skills. • Computer proficient in Microsoft Office including: Outlook, Word and Excel. Proficient in EPIC, Morrisey.

Certifications/Licenses Required

None

Work Environment

• Works in a normal office environment where there is no physical discomfort due to temperature, dust, noise, and the like. • The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.