What are the responsibilities and job description for the Provider and Payer Enrollment Analyst -Full Time-Days position at Cape Fear Valley Medical Center?
Facility
Cape Fear Valley Medical Center
Location
Fayetteville, North Carolina
Department
Physician Financial Services
Job Family
Professional
Work Shift
Days (United States of America)
Summary
The primary function of this position is to assist the Physician Revenue Cycle and Provider Enrollment teams by minimizing impact on Physician AR and improving enrollment process within CFV.
AR Responsibilities:
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Work with Physician Revenue Cycle on AR related issues related to payer enrollment discrepancies and credentialing issues.
- Create Strategic Plan for AR resolution as it relates to credentialing and payer enrollment to help minimize impact on cash and create workflows to improve payer enrollment process to be more effective.
- Assist Manager, PB Physician Billing and managed care team on payer resolution to reduce denials.
- Manage and oversee the release of providers and holding of providers in Epic to ensure timely resolution and denial reduction.
- Create Priority worklist based on outstanding or Problematic AR and engage other teams as needed such as Managed Care and Medical Group.
- Develop Measurement tool for completion of Enrollment and claim adjudication reducing lag to enroll for both groups and providers.
- Identify areas for improvement while mitigating payment disruption.
- Assist with creating standard operating procedures to ensure alignment for enrollment related tasks.
Enrollment Responsibilities
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Assist Director/ PB Revenue Cycle, Managed Care leaders and Provider Enrollment manager to expand delegated arrangements to expedite enrollment process and reduce delays and lag in enrollment process.
- Ensure payer system accuracy and assist by identifying problem areas for resolution.
- Work with Medical Staff Services (Ambulatory Group) on improving the acquisition of information to reduce provider and group enrollment lag (time to enroll) and improve communication flow.
- Work closely with Operational leaders to help improve communication flow and reduce barriers to provider enrollment.
- Assist provider enrollment team with workflows and operational improvements as needed.
Work on special projects such as:
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Tax ID integrity
- Work closely with Rev Integrity and Reimbursement for alignment and structure to reduce work effort and streamline enrollment process.
- Align Individual Group Tax ID to corporate strategic structure and help establish controls to ensure that structure and integrity is maintained.
- Assist in determination of new Software that will benefit CFV for both Medical Staff and Provider Enrollment and once selected help implement to maximize provider enrollment functionality and streamline workflows.
Inter Operational
- Work with Medical Staff Services on projects to ensure we are united and new project integration such as software requirements, delegated payer responsibilities and onboarding alignment.
- Work with Ambulatory group on throughput and communication processes to improve overall efficiency of enrollment activities.
- Work closely with IT on maintenance of provider tables/dictionaries to ensure that structure is maintained and managed.
Excellent interpersonal skills with the ability to interact with internal hospital department leadership as well as outside organizations. Possess and demonstrate strong written and verbal skills, be results oriented, and exemplify a team player attitude. Present a professional image. Expert skills in Microsoft Word, Excel, Powerpoint and Access or other software as required. Must be willing and able to work on a variety of activities and projects. Ability to work with people in a tactful, diplomatic manner.
Bachelor’s degree or, in lieu of degree, at least 10 years collective experience in Physician Accounts Receivable, Provider Enrollment, Provider Onboarding, Managed Care Contracting and Medical Staff Services as well as payer related duties relating to credentialing and enrollment.
Required Licenses and Certifications
Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity
