Provider Enrollment Specialist

Provider Enrollment Specialist

SALARY: TBD

REPORTS TO: Chief Operating Officer

SUMMARY: The Provider Enrollment Specialist works in conjunction with the leadership team to enroll and credential new and established providers with the all applicable payors. The Provider Enrollment Specialist will collaborate with the providers, human resource, office management, and recruitment to ensure the proper documents, necessary forms, and enrollment applications are completed accurately to enroll providers. 

DUTIES AND RESPONSIBILITIES:  

• The Provider Enrollment Specialists is expected to ensure the providers do not have a lapse in participation with payors or insurance companies to reduce unnecessary lost revenue or negative impacts to patients.
• The Provider Enrollment Specialists is to identify and mitigate payer enrollment issues or denials. 
• This position is responsible for researching, resolving, and enrolling any payer issues, utilizing a variety of tools. This may require contacting providers, operations personnel, leadership, commercial payors, private payors, or governmental payors including but not limited to the Centers for Medicare & Medicaid Services (CMS) via phone, email, or website.  
• Maintains documentation and reporting regarding payer enrollments in process and follows up when appropriate.
• Manages the completion and submission of CMS Medicare, State Medicaid and any other third-party payer applications, including initial and re-enrollments.
• Develops and maintains a database of all providers including their enrollment statuses, re-enrollment deadlines and a process to ensure statuses do not lapse or expire. 
• Communicates and coordinates with providers to ensure necessary and required documentation is kept up to date. 
• Performs follow up and research into enrollment or re-enrollment issues and mitigates those issues when possible. 
• Other duties and responsibilities as assigned

QUALIFICATIONS:

• Excellent verbal and written communication skills.
• Commitment to excellence and high standards.
• Strong organizational, problem-solving, and analytical skills; able to manage priorities and workflow.
• Ability to work independently and as a member of various teams and committees.
• Acute attention to detail.
• Ability to deal effectively with a diverse group of individuals at all organizational levels.
• Good judgement with the ability to make timely and sound decisions
• Demonstrated ability to plan and organize projects.
• Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm.

EDUCATION AND EXPERIENCE:

• Education: High School Diploma or Equivalent
• Experience: Three (3) years of provider enrollment experience
• Working knowledge of specific application requirements for Centers for Medicare & Medicaid Services (CMS), State Medicaid and all third-party payers including pre-requisites, forms required, form completion requirements, supporting documentation such as Drug Enforcement Agency Number (DEA), Curriculum Vitae (CV), and regulations
• Working knowledge of physician HIPAA Privacy & Security policies and procedures

COMPETENCIES:

• Customer Service--Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Interpersonal Skills--Focuses on solving conflict, not blaming; Maintains confidentiality; Listens to others without interrupting; Keeps emotions under control; Remains open to others' ideas and tries new things. 
• Oral Communication--Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings. 
• Written Communication--Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
• Teamwork--Balances team and individual responsibilities; Exhibits objectivity and openness to others' views; Gives and welcomes feedback; Contributes to building a positive team spirit; Puts success of team above own interests; Able to build morale and group commitments to goals and objectives; Supports everyone's efforts to succeed. 
• Change Management—Develops workable implementation plans; Communicates changes effectively; Builds commitment and overcomes resistance; Prepares and supports those affected by change; Monitors transition and evaluates results 
• Delegation--Delegates work assignments; Matches the responsibility to the person; Gives authority to work independently; Sets expectations and monitors delegated activities; Provides recognition for results.
• Leadership--Exhibits confidence in self and others; Inspires and motivates others to perform well; effectively influences actions and opinions of others; Accepts feedback from others; Gives appropriate recognition to others.
• Managing People--Includes staff in planning, decision-making, facilitating and process improvement; Takes responsibility for subordinates' activities; Makes self-available to staff; Provides regular performance feedback; Develops subordinates' skills and encourages growth; Solicits and applies customer feedback (internal and external); Fosters quality focus in others; Improves processes, products and services; Continually works to improve supervisory skills. 
• Diversity--Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; educates others on the value of diversity; promotes a harassment-free environment; Builds a diverse workforce.
• Ethics--Treats people with respect; Keeps commitments; inspires the trust of others; Works with integrity and ethically; Upholds organizational values.
• Judgment--Displays willingness to make decisions; Exhibits sound and accurate judgment; Supports and explains reasoning for decisions; Includes appropriate people in decision-making process; Makes timely decisions.
• Professionalism--Approaches others in a tactful manner; Reacts well under pressure; Treats others with respect and consideration regardless of their status or position; Accepts responsibility for own actions; Follows through on commitments. 
• Quality--Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. 
• Safety and Security--Observes safety and security procedures; Determines appropriate action beyond guidelines; Reports potentially unsafe conditions; Uses equipment and materials properly.
• Adaptability--Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
• Attendance/Punctuality--Is consistently at work and on time; Ensures work responsibilities are covered when absent; Arrives at meetings and appointments on time. 
• Dependability--Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan. 

Equal Employment Opportunity

It is the policy of AKP to provide equal employment opportunity to all employees and applicants for employment and not to discriminate on any basis prohibited by law, including race, color, sex, age, religion, ancestry, national origin, marital status, veteran status, or other legally protected group status. It is our intent and desire that equal employment opportunities will be provided in employment, recruitment, selection compensation, benefits, promotion, demotion, layoff, termination and all other terms and conditions of employment. AKP is committed to this policy and its enforcement

Other Duties

Travel:  Travel is required between the various Angel Kids Pediatrics locations at times.

Work Environment

This job operates in a professional medical office environment.   This job also operates in a fast paced, highly customer service environment, working with Children and Family/ Guardian’s.  This role routinely uses standard office equipment such as laptop computers and smartphones as well as medical equipment.

Physical Demands

While performing the duties and responsibilities of office manager, you will be required to stand, walk or sit for long hours.  The employee must be able to occasionally move or lift at least 10 lbs.  The employee must be able to communicate efficiently in front of large or small crowds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus. 

Position Type/Expected Hours of Work

This is a full-time position expected to work 40 hours per week.