What are the responsibilities and job description for the Payer Enrollment Specialist position at National Spine & Pain?
Job Description
Job Description
Description :
The Payer Enrollment Specialist coordinates and facilitates the enrollment of National Spine & Pain Centers professional and surgery center providers and facilities with various payers for service reimbursement. Responsible for obtaining and maintaining payer participation by timely completion of payer applications for submission to government and commercial health plans. Performs continuous follow ups on enrollment application submissions to meet provider start dates and deadlines. Assists in resolving enrollment issues as they relate to claims payment. Maintains credentialing system with accurate notes and provider statuses for collaborative flow of information from department to field.
- Handles highly sensitive and confidential information regarding professional providers.
- Completes provider payer enrollment / credentialing and re-credentialing with all identified payers in a timely manner.
- Maintains positive working relationships to foster collaborative open communication with departmental team, physicians, non- physicians, office staff, management, contracting, insurers, and others as identified.
- Resolves enrollment issues as identified on monthly holds report provided by Revenue Cycle department.
- Appropriately submit clean applications to payers along with supporting documentation to aid in timely processing.
- High level performance to meet KPI standards by ensuring that workflows are followed to document submissions, follow ups and participation status.
- Maintain and update provider files, rosters, and enrollment databases, including but not limited to delegation rosters, CAQH profiles, payer databases, NPI database, PECOS, and any others as needed.
- Remain abreast of current health plan and agency requirements for credentialing of providers.
- Provides weekly updates to on-site practice management staff and others with enrollment statuses and any changes to requirements for credentialing individual providers based on government and commercial payer credentialing processes. Proactively communicated any changes regarding contracting / credentialing as it relates to enrollment and operations.
- Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and teamwork with departments, vendors, etc.
- Utilizes credentialing database and spreadsheets for tracking organization providers. Ensures data is accessible / transparent for executive inquiries or other information as deemed necessary by management.
- Continuously searches for process improvements to achieve accuracy and efficiency.
- Performs other duties as assigned or required.
Requirements :
