What are the responsibilities and job description for the PROVIDER ENROLLMENT SPECIALIST position at Fort Defiance Indian Hospital?
Closing Date: Open Until filled.
Salary Range: $23.52 - $28.69/hour
**APPLICANT MUST HAVE A VALID, UNRESTRICTED INSURABLE DRIVER’S LICENSE**
**RESUMES AND REFERENCES ARE REQUIRED**
ESSENTIAL DUTIES, FUNCTIONS AND RESPONSIBILITIES
• Coordinates and ensures providers receive enrollment forms and packets where applicable, responds to all inquiries regarding enrollment using timely and effective communication with providers, programs, and other credentialing staff.
• Submits new provider enrollment applications via electronic online provider enrollment portals and will track online applications through all stages in order to accurately enroll each provider with commercial, Medicare and State Medicaid payers.
• Assist with updates and/or modifies provider enrollment for current and returning providers with Medicare and State Medicaid plans, to ensure that all billable providers are appropriately linked to the correct facility. Maintains and recognizes effective processes for monitoring provider enrollment status for all commercial, Medicare and State Medicaid health plans. Reviews and submits accurate enrollment applications.
• Assists with submitting Medicare revalidations for Facility in a timely manner with Medicare to avoid loss of billing privileges.
• Submits the Provider Contract Request Form along with other required documentation to Blue Cross Blue Shield (BCBS) and Tricare payers for all medical providers, this is to ensure linking of medical providers to the Fort Defiance Indian Hospital Board, Inc. Facility NPI’s.
• Communicates with other internal and/or external credentialing staff and supervisors on any deficiencies. Follows up on all submitted and outstanding documents for providers. Obtains all applications and supporting documents for State Medicaid, Medicare, and commercial plans from providers and keep on file electronically for audits purposes.
• Maintain deadlines and enrollment schedules by tracking files through all stages of the enrollment process.
• Assists provider’s with completing and updating of their Council for Affordable Quality Healthcare (CAQH) profiles.
• Completes the provider turnaround document (TAD) to New Mexico Medicaid, by deadlines scheduled by payers.
• Notifies Medicare and State Medicaid Plans of the appropriate end date for exiting medical providers within 1 (one) year after departure.
• Responsible for providing and updating a provider listing to the Director of Revenue Generation, which consists of provider NPI information, department, title, state licensure, expiration dates, start date, and payers assigned provider numbers for active, consulting, and inactive providers. In addition, to provide a weekly productivity summary report to direct supervisor.
• Performs other duties as assigned.
MANDATORY MINIMUM QUALIFICATIONS:
Experience:
Two (2) years enrollment experience in a healthcare environment.
Education:
Associate Degree or equivalent experience
Please email degree or transcripts to trent.begay@fdihb.org
NAVAJO/INDIAN PREFERENCE:
FDIHB and its facilities are located within the Navajo Nation and, in accordance with Navajo Nation law, has implemented a Navajo/Indian Preference in Employment Policy. Pursuant to this Policy, applicants who meet the minimum qualifications for this position and who are enrolled members of the Navajo Nation will be given primary preference in hiring and employment for this position and members of other federally recognized Indian tribes will be given secondary preference. Other candidates will be considered only after all candidates entitled to primary or secondary preference have been fully considered.
Salary : $24 - $29
