Provider Enrollment Specialist
Posted 7ds ago
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Job Description
Provider Enrollment Specialist resolving CMS, Medicaid, and payer enrollments for Ventra Health’s physician revenue-cycle services. Tracking applications, provider numbers, demographics, and revalidations.
Responsibilities:
- Identify provider payer enrollment issues or denials with the Provider Enrollment Manager
- Research and resolve payer enrollment issues through proprietary and external tools
- Contact clients, operations personnel, CMS, and other payers by phone, email, or website
- Follow up with market locations to research and resolve payer enrollment issues
- Complete and submit CMS Medicare, State Medicaid, and third-party payer applications
- Track and follow up to establish provider numbers and link them to the appropriate client group entities and software systems
- Maintain documentation and reporting for payer enrollments in process
- Retain records related to completed CMS applications
- Build working relationships with clients, Operations, and Revenue Cycle Management
- Obtain, track, and manage payer revalidation dates; submit and track applications to maintain active enrollment and prevent deactivation
- Maintain provider demographics in applicable enrollment systems
- Add providers to applicable systems and maintain information so claims are held or released based on enrollment status
- Perform special projects and other assigned duties
Requirements:
- Associate's degree (2 years), required
- Bachelor's degree in any related field, preferred
- At least one (1) year of provider enrollment experience preferred
- Working knowledge of application requirements for CMS, State Medicaid, and third-party payers
- Knowledge of prerequisites, required forms, completion requirements, supporting documentation, 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, analytical, decision-making, problem-solving, organizational, and time management skills
- Ability to complete and verify complex enrollment packages
- Ability to work independently and in a team-oriented, collaborative, fast-paced environment
- Ability to maintain strict confidentiality regarding protected provider and health information
- Ability to troubleshoot, take initiative, exercise sound judgment, and handle sensitive information appropriately
Benefits:
- Performance-based incentive plan
- Discretionary incentive bonus
- Referral bonus
- Remote work arrangement
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