Provider Enrollment Specialist

The Provider Enrollment Specialist is responsible for merging, completing and following up on provider applications with third-party payers by coordinating with enrollment vendors, payors, and internal stakeholders. This position serves as the department’s Subject Matter Expert for all group and/or provider enrollment disclosure of ownership and group enrollment questions. Documents and records all group related information in the Provider Enrollment system and other applicable systems. Strong attention to detail, balanced with the ability to produce a high output of applications, is essential to this role.

• Complete a variety of third-party payer applications for all LHC Group providers.
• Completes and distributes W-9 forms.
• Monitor any and all demographic changes. Update internal systems with new information and provide updates to payors based on their requirements.
• Maintain current status notes in database/spreadsheets and ensure timely follow up on initial enrollment, re-credentialing and expirables.
• Research and resolve enrollment and claims issues.
• Initiate contact with payors and practices via telephone or electronic methods with respect to provider enrollment initiation or billing errors, utilizing proper customer service protocol.
• Prepare and review all group Disclosure of Ownership “DOO” (Government and Commercial) and group enrollment and re-enrollment applications, as required.
• Upon receipt of approval, Communicate enrollment updates and/or questions to our third-party billing vendors as well as internal departments.
• Establish and maintain a strong professional rapport with providers, third party payers, clients and internal staff.
• Assist during payor-delegated credentialing audits.
• Review correspondence received and perform appropriate action to resolve.
• Appropriately resolve or escalate payor application denials.
• Meet and maintain established departmental performance metrics for production and quality.
• Maintain working knowledge of workflow, systems, and tools used in the department.
• Serves as the company expert for all group provider enrollment related activity.
• Research and coordinate the gathering of payor requirements such as, but not limited to state regulations, processing time, change of ownership process and required documentation, backdate requests, health plan backlogs, required group enrollment documentation, adverse legal history, authorized-delegated information and payer timeframes for submission.
• Other duties as assigned.

Formal Education

• High school diploma or equivalent; College education preferred

Experience

• 1 years of administrative experience

License, Registration and/or Certification Requirements

• n/a

Experience Desired

• Minimum one-year related healthcare experience preferred, such as Medicare/Medicaid Enrollment or Managed Care Enrollment

Skill Requirements

• Must be highly organized, efficient, and able to handle multiple tasks with ease and professionalism.
• Must possess administrative, analytical, problem-solving, and time management skills.
• Must be able to make sound decisions based on urgency, fact, guidelines, goals, and regulations
• Must have a thorough working knowledge of computers and applicable office software including Microsoft Office Suite (Outlook, Word, Excel, Access, Power Point), internet research, and database programs.