JOB SUMMARY: Completes accurate and timely payor enrollment applications and coordinates workflow.

EDUCATIONAL REQUIREMENTS:

• High school diploma required
• CPCS or CPMSM certification preferred
• College education or trade school preferred

QUALIFICATIONS AND EXPERIENCE:

• 2-3 years Provider enrollment experience
• Experience navigating CAQH, and individual insurance carrier websites.
• Knowledge of Federal and State regulatory requirements, and accreditation standards.
• Good understanding of medical terminology
• Ability to work independently with minimal supervision. Strong organizational, and time management skills needed.
• Comfortable using email and interacting with Internet applications
• Strong written and verbal communication skills

Responsibilities include, but are not limited to, the following:

• Tracks license and certification expirations for all providers to ensure timely renewals.
• Maintains the Provider Enrollment database.
• Ensure the integrity of the provider enrollment process
• Process enrollment applications for government and commercial health plans payors, and manage the ongoing participation requirements of the plans for all Practitioners.
• Access external databases to obtain primary source documents necessary to complete payor applications.
• Interact with representatives from health plans to respond to inquiries, and return correspondence in a timely manner.
• Facilitate securing and maintaining up to date practitioner licenses, DEAs, and NPI numbers.

Other Responsibilities:

• Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice
• Maintains detailed knowledge of practice management and other computer software as it relates to job functions
• Attends Revenue Cycle staff meetings
• Performs any additional duties as requested by the Director

Supervisory Responsibilities

This job has no supervisory responsibilities.

Typical Physical Demands

Work may require sitting for long periods, and also stooping, bending and stretching for files and supplies. Position requires manual dexterity sufficient to operate a keyboard, operate a computer, telephone, copier, and other office equipment as necessary. Position also requires viewing computer screens and typing for long periods.

Typical Working Conditions

Work performed in a quiet, professional office setting.