What are the responsibilities and job description for the RCM Certification and Enrollment Specialist position at Fresenius Medical Care?
PURPOSE AND SCOPE:
This position is responsible for:
State Medicaid application process
Medicare EDI enrollment.
ERA, EFT, Claims Enrollment
DDE and payer website access
Applications for specific non-network payors
Functions as a centralized group to best serve the Business for all enrollment needs. Provide visibility to the organization on the status of facilities during the enrollment processes. Cultivate and maintain a professional relationship with industry partners.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Follow Acquisition, Joint Venture and DeNovo facility from rumor to completion (point of billing)
Participate in the acquisition, JV conversion and new facility calls
Assists Regulatory with CMS 855 application issues & follow up
Track completion of state license and CLIA
Monitor for expiration of state licenses and provide current documents to State Medicaid
EDI Enrollment with Medicare Administrative Contractor (MAC)
Facility setup for Electronic Claims in Relay Health
Establish connection with Corporate DSD EDI
Add PTAN's to MDE transmission via Relay Health
Complete Medicaid applications to include all required facility documents and managing employee Medicaid Disclosure Questionnaire's (MDQ). Work with internal Regulatory and Legal teams to ensure all disclosure information is current and accurate
Document management - KIMA/ExtraView and the EDS Team SharePoint site
Medicaid Re-credentialing
Medicare PTAN, Medicaid provider #, and location addresses updates in Facility Database
Facility relocation reporting to state Medicaid programs
Revenue Center assignment in Big Wave system
Medicare DDE enrollment and recertifications
Establish/terminate Revenue Centers and Cash Departments access to all insurance payer websites
Commercial payer enrollment for EFT, ERA and electronic claims
Reenroll commercial payors for ERA, EFT, Claims
Tricare applications for non-network participation
Blue Cross Blue Shield applications for out of network provider numbers.
Create and maintain all W9's
Other duties as assigned
Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION:
High School Diploma
EXPERIENCE AND REQUIRED SKILLS:
Minimum 1 year experience in medical accounts receivable
Strong time management skills and the ability to juggle multiple tasks
High level of creativity, innovation, initiative, and sense of ownership
Organizational capabilities and strong attention to detail
Self-motivated, quick learner and independent thinker
Must be able to work well independently, and in a team environment
Must be capable of quickly identifying issues and provide recommendations
Excellent verbal/written and communication skills
Proficient in MS Excel
Protect highly sensitive and confidential information
EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity
Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.
