What are the responsibilities and job description for the Provider Enrollment Specialist - Managed Care position at UTMB Health Careers?
Required Education / Experience:
Associate’s Degree or equivalent and three years of financial, credentialing, billing, or related experience in a healthcare organization.
Job Description:
The Provider Enrollment Specialist is responsible for coordinating, monitoring and maintaining the provider enrollment and re-enrollment process in a timely and compliant manner with all government and commercial payors. Facilitates all aspects of provider enrollment, including initial enrollment, re-enrollment, monitoring, and appointment for the medical staff and allied health practitioners. Assists with problem identification and timely resolution of payor related issues surrounding claim submission and denial management to ensure optimal reimbursement. Position serves as the liaison between managed care plans and UTMB, including Revenue Cycle Operations and the Faculty Group Practice, to resolve any billing issues related to provider enrollment and promote optimal reimbursement.
Essential Job Functions:
- Facilitate enrollment of new UTMB providers to ensure proper and timely billing and collections
- Prepare enrollment applications for all health plans including Medicare and Medicaid
- Complete data entry and processing of enrollment applications, with validation of provider submitted information to ensure the application is complete, accurate, and meeting UTMB standards
- Obtain licensure, certification and insurance certificates at time of enrollment and maintain in database in order to submit with enrollment applications
- Maintain timelines on enrollment processes, and address and/or escalate any delays
- Ensure that all pending enrollments are reviewed, obtained and managed according to the rules and policies of the department
- Provide monthly notification of new providers, resignations, and changes in provider status such as practice locations and panel status to contracted plans
- Follow up with necessary contacts, including providers and managed care organizations, to resolve enrollment application issues and deficiencies
- Facilitate resolution of provider related denials to ensure appeal procedures are followed to result in proper reimbursement
- Demonstrate a level of competence and understanding of all state and federal laws, rules and regulations according to payer guidelines for billing
- Respond to internal and external inquiries on routine enrollment and contract matters, as appropriate
- Perform detailed follow-up activities on assigned accounts according to procedures
- Resolve outstanding AR accounts at a defined level of productivity
- Maintain confidentiality of all provider enrollment business/work and medical staff information
Marginal Or Periodic Job Functions:
- Prioritize and complete all work in an accurate, effective and efficient manner
- Participate in team meetings/activities and support the philosophy and goals of the team and department
- Participate in special projects/assignments
- Read all announcements and relevant communications relating to job duties
- Successfully complete competency based training and testing
- Perform related duties as required
Knowledge/Skills/Abilities:
- Knowledge of insurance claim processing and third party reimbursement.
- Knowledge of state and federal regulations as they pertain to billing processes and procedures.
- Ability to understand and interpret statistical reports and perform quantitative analysis.
- Knowledge of the principles of Information Systems in order to effectively analyze and make decisions, preferably with experience in Epic and database management.
- Skill in effective oral, written, and interpersonal communication.
- Skill in time management and project management.
- Ability to work efficiently under pressure.
- Ability to operate a computer and related applications.
- Ability to work independently and take initiative.
- Ability to demonstrate a commitment to continuous learning and to operationalize that learning.
- Ability to deal effectively with constant changes and be a change agent.
- Ability to deal effectively with challenging situations.
- Ability to willingly accept responsibility and/or delegate responsibility.
Salary Range:
Actual salary commensurate with experience.
Equal Employment Opportunity
UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.
