Job detail

Provider Enrollment Specialist

Easterseals MORC

#Data Entry #Confidentiality #Collections #Billing #Federal Laws #State Laws #Medicare #Medicaid #Certification #Credentialing

Quick overview

This role is responsible for facilitating the enrollment of new providers to ensure timely billing and collections by preparing and processing enrollment applications for various health plans, including Medicare and Medicaid. Key duties involve maintaining accurate provider data, managing required documentation like licensure and insurance, and ensuring adherence to all enrollment timelines and departmental policies.

Requirements summary

The specialist must accurately complete data entry and validation for enrollment applications, ensuring all provider information meets organizational standards and payer guidelines. Responsibilities also include proactively managing enrollment processes, resolving application deficiencies and denials, and maintaining detailed records of provider participation status with insurance plans.

ConfidentialityPolicy AdherenceData EntryDenial ResolutionIssue ResolutionValidationInquiry ResponseEnrollmentReimbursementPayer GuidelinesApplication ProcessingEscalationLicensure MaintenanceTimelines ManagementNotificationAppeal Procedures

Job description

1.
Facilitate enrollment of new Easterseals MORC providers to ensure proper and timely billing and collections 2.
Prepare enrollment applications for all health plans including Medicare and Medicaid 3.
Complete data entry and processing of enrollment applications, with validation of provider submitted information to ensure the application is complete, accurate, and meeting Easterseals MORC standards 4.
Obtain licensure, certification and insurance certificates at time of enrollment and maintain in database in order to submit with enrollment applications 5.
Maintain timelines on enrollment processes, and address and/or escalate any delays 6.
Ensure that all pending enrollments are reviewed, obtained and managed according to the rules and policies of the department 7.
Provide monthly notification of new providers, resignations, and changes in provider status such as practice locations and panel status to contracted plans 8.
Follow up with necessary contacts, including providers and managed care organizations, to resolve enrollment application issues and deficiencies 9.
Facilitate resolution of provider related denials to ensure appeal procedures are followed to result in proper reimbursement 10.
Demonstrate a level of competence and understanding of all state and federal laws, rules and regulations according to payer guidelines for billing 11.
Respond to internal and external inquiries on routine enrollment and contract matters, as appropriate 12.
Perform detailed follow-up activities on assigned accounts according to procedures 13.
Resolve outstanding AR accounts at a defined level of productivity 14.
Maintain confidentiality of all provider enrollment business/work and medical staff information 15.
Identifies issues requiring additional investigation and evaluation; validate discrepancies and ensure appropriate follow up.
16.
Retains detailed and accurate lists of insurance plans in which providers participate and their effective dates with each plan.
17.
Responds to inquiries from payer organizations regarding credentialing and privileging issues as they arise.
18.
Performs follow up with insurance plans to resolve provider enrollment issues and obtain provider participation status.

Provider Enrollment Specialist

Quick overview

Requirements summary

Job description

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