What are the responsibilities and job description for the Payor Enrollment Specialist position at Harbin Clinic?
Primary Responsibilities:
- Create provider records in the practice management system
- Manage and complete provider enrollment applications
- Maintain participation with managed care organizations as defined by Payer Contracting
- Maintain participation with Medicaid and Medicare services including MA and CMO plans
- Facilitate claims billing by maintaining payer assigned privileges and billing numbers in the practice management system
- Maintain enrollment dashboard and payer enrollment table within practice management system
- Complete electronic remittance advice (ERA) enrollments and prepare electronic funds transfer (EFT) documents for CFO signature
- Collaborate with various insurance carriers, internal and external team members to resolve payer questions and issues.
- Maintain documentation and reporting regarding provider enrollments in process within the credentialing database
- Responsible for understand specific application requirements for each payer including pre-requisites, forms required, licensure, CLIA, supporting documentation and regulations.
- Research payer enrollment guidelines as needed for non-contracted payers.
- Provide enrollment status reports to management and key personnel
- Responsible for claims follow up for denials and edits related to payer enrollment
- Maintain referring provider billing table
- Maintain DEA license within the practice management system
- Set up departments in practice management
Education Requirement :
- Proficiency in Athena practice management highly preferred
- A minimum of three to five years of relevant work experience in payer enrollment, credentialing, or claims billing/follow up required. Must possess or be willing to develop general knowledge of CAQH, PECOS, and credentialing systems.
Skill Requirement:
- Must have strong computer skills
- Excellent organizational skills
- Excellent verbal and written communication skills.
- Strong interpersonal skills including the ability to effectively communicate with persons internal and external the organization, including physicians and other staff.
Attributes and Qualifications Requirements:
- Ability to work independently
- Ability to exercise judgement and make decisions
- Ability to multi-task
