Job Summary:
To perform and ensure the quality and timeliness of provider enrollment functions and to ensure adherence to payor contracts.
Job Duties:
Perform provider enrollment functions including but not limited to NPI application system, enrollment applications for government payors such as Medicare and Medicaid, and enrollment activities for commercial payors. Track provider enrollment applications to ensure timely enrollment and linkage of providers and payors. Document and assist in resolving issues involving provider enrollment. Complete the re-attestation task for all applicable staff.
Prepare hospital and outpatient facility applications and coordinate with clinical staff to obtain signatures and necessary documentation promptly. Respond to all re-credentialing and revalidation requests within the given time frame. Maintain HIPAA compliance and confidentiality at all times and protect all personal health information as it relates to patient data. Other duties may be assigned.
SUPERVISORY RESPONSIBILITIES
This job has no supervisory responsibilities.
Qualifications:
EDUCATIONAL REQUIREMENT
One-year certificate from a college or technical school; or one and one-half years of related experience; or an equivalent combination of education and experience.
EXPERIENCE REQUIREMENT
An additional six (6) months of experience in a related field.
COMPUTER SKILLS
An individual should know Database software; Internet software; Spreadsheet software and Word Processing software.
CERTIFICATES, LICENSES, REGISTRATIONS
None required.
OTHER QUALIFICATIONS
Employee must not be and will not be under sanction by the United States Department of Health and Human Services Office of the Inspector General (OIG) or by the General Services Administration (GSA) or listed on the OIG’s Cumulative Sanction Report, or the GSA’s List of Excluded Providers; pr listed on the OIG’s List of Excluded Individuals/Entities (LEIE).
PHYSICAL DEMANDS
While performing the duties of this Job, the employee is regularly required to sit and use hands to finger, handle, or feel. The employee is frequently required to talk or hear. The employee is occasionally required to reach with hands and arms.
WORK ENVIRONMENT
The noise level in the work environment is usually moderate.
