Provider Enrollment Specialist (Temporary for 9-12 Months) - Remote - Nationwide

At Vituity you are part of a larger team that is driven by our purpose to improve lives. We are dedicated to transforming healthcare through our culture by working together to tackle healthcare’s most pressing challenges from the inside.

About the role

Prepare, submit, and scan approximately 1,000 provider enrollment applications per year for Medicare, Medicaid, Blue Cross, Blue Shield, CAQH, and other payer programs. Responsible for all aspects of payer portal access for individual providers.

• Submit all applications to supervisor/manager for audit, working towards an error rate of less than 10%.
• Monitor submitted provider enrollment applications to ensure approvals are received and communicated to the billing team prior to timely filing, working towards the team’s overall goal of not having pending applications over 6 months after the start date.
• Manage daily administrative duties with an emphasis on enhancing efficient workflows.
• Prioritize requests, manage time, and workload to execute project plans within given deadlines.
• Work remotely full-time with the ability to work independently with little guidance and adapt.
• Respond to internal and external inquiries on routine enrollment and contract matters, including follow-up with payers on applications as frequently as every 2 weeks.
• Serve as liaison between billing company, providers, and payer representatives to resolve all provider enrollment issues with assistance from supervisor/manager.
• Coordinate credentialing process with assistance of an on-site administrator as needed to complete credentialing for initial, updating, and add-on applications and maintenance processes.
• Communicate with providers and other departments to update as needed, clarify carrier information requirements, and maintain a strict level of confidentiality for all matters pertaining to provider credentials.
• Perform Salesforce configuration changes including but not limited to record types, dashboards, reports, and custom settings.
• Update records in Salesforce with billing numbers, contract information, submission dates of applications, and notation of any communications or problems that require attention.
• Record extensive documentation in databases for any ongoing or open tasks.
• Use Salesforce data loader for bulk import of data to individual enrollment contracts.
• Use DocuSign to send out provider enrollment documents, obtain required client signatures, and follow up with the carriers on documentation submitted.
• Deactivate inactive providers from Medicare, Medicaid, and other payers to remain compliant with federal and state regulations.
• Ensure data integrity and participate in trainings and development to mitigate compliance risk with state and federal regulations.
• Work with multiple departments to review proforma for new contracts and assist to protect revenue.
• Research numerous payer issues and work to resolve them with payers and billing company quickly and effectively with oversight from supervisor/manager, with the overall goal to lose less than $100K in revenue per year.
• Contribute and assist with implementation of process improvement ideas by participating in payer trainings and webinars as needed.
• Support research, review, and testing of educational materials for organization growth.

Requirements

• High School Diploma in combination with relative work experience required.
• 2-4 years related healthcare experience required.
• Bachelor’s degree is preferred.
• 3+ years of related healthcare experience preferred.
• Knowledge of billing or reimbursement is desired.
• Provider Enrollment experience is desired.
• Ability to effectively interact with providers, payer representatives, internal departments, team members, and other stakeholders, both in written and verbal communication.
• Ability to accomplish tasks thoroughly and accurately.
• Ability to effectively manage time and organize.
• Ability to learn billing processes, including timely filing and claims denial reasons.
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, OneDrive, PowerPoint, etc.).
• Knowledge of additional technology-based assistance (Teams, SharePoint, etc.).
• Knowledge of online Medicare/Medicaid enrollment systems, Identity & Access system, Counsel for Affordable Quality Healthcare system, Medicare enrollment specialties, and National Provider Identifier taxonomies.
• Knowledge of Medicaid enrollment process (including revalidations, medical license expirations, deactivations, NPI taxonomy importance, how data flows to Medicaid managed cares, Medicaid billing manuals, state administrative codes, border state enrollment process, out-of-state enrollment process, etc.).
• Knowledge of Salesforce (including Individual Enrollment Contracts, Group Enrollment Contracts, Contracts, Work History, Provider Status, and Clinical Activities objects), and utilizing dashboards and reporting to develop internal preference for ongoing workload management.
• Develop critical thinking skills and professional relationships.

Benefits

• Superior health plan options.
• Dental, Vision, HSA/FSA, Life and AD&D coverage, and more.
• Top Tier 401(k) retirement savings plans that offer a $1.20 match for every dollar up to 6% plus discretionary profit-sharing contributions (eligible January following 18 months of service).
• Generous paid time off starting at 3-4 weeks annually.
• Student Loan Refinancing Discounts.
• Professional and Career Development Program.
• EAP and travel assistance included.
• Wellness program.
• Monthly wellness events and programs such as yoga, HIIT classes, and more.
• Trainings to help support and advance your professional growth.
• Team building activities such as virtual scavenger hunts and holiday celebrations.
• Flexible work hours.
• Opportunities to attend Vituity community events including LGBTQ+ History, Día de los Muertos Celebration, Money Management/Money Relationship, and more.

*Benefits for part-time and per diem vary. Please speak to a recruiter for more information.

Pay

The base salary range for this position is $22.90 - $28.63, exclusive of fringe benefits or potential bonuses. This position is also eligible to participate in our annual corporate Success Sharing bonus program, which is based on the company’s annual performance. Final base salary compensation will be determined based on factors such as skills, education, and/or experience.