Coordinator III

Job Description

Job Description

PRESCREEN THAT NEEDS TO BE AT TOP OF EACH RESUME :

• Location at tope of resume
• Medicare experience? If yes, how many years of exp and a brief summary of exp
• Medicaid experience? If yes, how many years of exp and a brief summary of exp
• Brief summary of candidates excel experience

It will be in office 4 days a week, and once trained there is an option to work from home on Fridays.

200 Highland Corporate Drive

Cumberland, RI 02864

POSITION SUMMARY :

This position is responsible, under the supervision of the Manager of the Payer Enrollment Dept. to :

Ensuring timely and accurate processing of Payer Enrollment applications (Initial and Revalidations) for Clinics and Providers.

Provide quality control for timely and accurate individual enrollment applications submitted for Medicare and Medicaid programs.

Resolve claims issues for individual payers in corporate billing system.

Researching, completing and maintaining compliance with individual Government payers through credentialing, re-credentialing and audit processes and procedures.

Contact Providers when Revalidation notices are received in order to obtain signature pages and validate current general information. Interact with the field (SPM and CPM's) in regards to escalation notices.

The Payer Enrollment Coordinator will be responsible for identifying and quantifying trends / issues and then effectively communicating them to the appropriate members of the management team along with what the potential impact could be.

Minimize denials and deactivation of government applications where applicable to reduce key metrics including DSO, cost to collect, percent of aged claims, and Bad Debt.

Update Credentialing and Billing systems with Provider information upon inquiry or receipt from Government / Commercial payers.

The Payer Enrollment Coordinator will be responsible for ensuring corporate compliance with statutory requirements for Medicare, Medicaid, and Commercial enrollment for Clinics and Providers. This Individual will have the ability to work well with others; collaboratively with internal and external vendors and create partnerships through effective relationship building skills. This role will interact and work directly with new and existing Government / Commercial payers across the country. Analysis will include developing of provider and clinic level reporting insuring we are meeting all criteria for enrollment within our compliance policy for Government / Commercial. Payer Enrollment Coordinator will interface and work directly with the Providers, and also with Payer Relations and Revenue Cycle Operations Teams (Credentialing, Accounts Receivable, Billing, and Call Center) Clinical Ops Teams, and MinuteClinic Field and Operations Management, in order to ensure integration of all processes.