What are the responsibilities and job description for the Enrollment Specialist- Remote position at GetixHealth?
Responsibilities:
- Enroll, Update and confirm group EDI/ERA/EDI enrollments through hard copies or payor portal.
- Perform the initial provider enrollment and recertifying functions for employed and contracted practitioners. This may include collaborating with physicians, nurse practitioners, and Locum Tenens.
- Maintain timely and accurate data entry and periodically revise practitioner data in the credentialing database; maintain practitioner electronic data files for practitioners; use the CAQH system to submit practitioner data as required by some client health plans to enroll individual practitioners.
- Enroll practitioners with all appropriate client health plans; monitor and report on progress of each practitioner.
- Enroll government payers using electronic method such as PECOS and payer portals.
- Monitor expiring licensure, board and professional certifications and other expirable documents with practitioners within the prescribed time frames as outlined in the policies and procedures.
- Identify, analyze and resolve extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to enroll practitioners.
Requirements:
- Minimum of 2 or more years of experience in Health Care and Enrollment services.
- Knowledge and understanding of payor portals to complete group and provider enrollments as well as EDI/EFT/ERA.
- Familiarity with practitioner billing and claims payment system requirements as related to practitioner enrollment.
- Requires exceptional critical thinking skills, sound judgment and the ability to communicate in an articulate manner with practitioners, administrators, and client credentialing personnel.
- Experience with Microsoft Office and Excel
- Prior use of common Credentialing Tracking Software, such as Verity or Modio
Preferred:
- Athena billing systems a plus
- Prior experience with Medical Payer enrollment, Medical Staffing and Privileging.
- Certification in Credentialing/Enrollment services.
- Experience with National Committee for Quality Assurance, URAC and/or The Joint Commission guidelines and standards related to provider enrollment.
