What are the responsibilities and job description for the Enrollment Specialist- Remote position at GetixHealth?
Responsibilities:
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Group Enrollment & Updates: Process, update, and confirm group EDI/ERA/EDI enrollments via hard copies or payer portals, ensuring accuracy and efficiency.
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Provider Enrollment & Recertification: Manage the initial provider enrollment and recertification process for employed and contracted practitioners, including collaborating with physicians, nurse practitioners, and Locum Tenens.
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Data Management & Maintenance: Ensure timely and accurate data entry for practitioner information in the credentialing database; periodically revise and update practitioner records. Maintain electronic data files and use the CAQH system for submitting practitioner information to client health plans.
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Health Plan Enrollment: Enroll practitioners with appropriate client health plans and monitor the progress of each enrollment.
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Government Payer Enrollment: Facilitate enrollment with government payers using electronic methods such as PECOS and payer portals.
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Document Monitoring & Compliance: Monitor the expiration of licensure, board certifications, and other critical documents for practitioners, ensuring compliance with established policies and procedures.
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Issue Resolution: Identify, analyze, and resolve discrepancies, time gaps, and other issues that may impact the ability to enroll practitioners.
Requirements:
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Experience: A minimum of 2 years in healthcare and enrollment services.
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Payor Portal Expertise: Knowledge of payor portals for group and provider enrollments, as well as EDI/EFT/ERA processing.
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Billing & Claims Familiarity: Understanding of practitioner billing and claims payment system requirements in relation to practitioner enrollment.
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Critical Thinking & Communication: Strong critical thinking skills, sound judgment, and the ability to communicate clearly with practitioners, administrators, and client credentialing personnel.
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Technical Skills: Proficient in Microsoft Office and Excel.
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Credentialing Software: Prior experience using credentialing tracking software such as Verity or Modio.
Preferred Qualifications:
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Athena Billing Systems: Experience with Athena billing systems is a plus.
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Medical Enrollment & Staffing: Previous experience in medical payer enrollment, medical staffing, and privileging.
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Certification: Certification in Credentialing/Enrollment services is preferred.
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Regulatory Knowledge: Familiarity with National Committee for Quality Assurance (NCQA), URAC, and The Joint Commission guidelines and standards related to provider enrollment.
