Please read job requirements before applying. Must also apply at www.mhmrtc.org

Job Requirements:

Education:

High School Diploma or GED

At least 3 years Credentialing experience

This position is responsible for supporting the enrollment and credentialing processes by coordinating, submitting and monitoring provider enrollments within MHMR for Programs that bill third party funds for services rendered. This position will assist with proactively identifying and resolving enrollment and credentialing related issues quickly so that MHMR does not lose revenue for services provided to our members. This position supports Enrollments, Credentialing, PFS Department and other agency Programs to ensure appropriate training, communication and resources are implemented and that MHMR receives the maximum reimbursement due for services rendered. In compliance with HIPAA, this position will also monitor and maintain access for all staff to various third party payor, provider relations and claim-related websites that enable accurate and expedited resolution to provider enrollment, MHMRTC claim processing and member access to services.

II) Essential Functions

1. Develops, implements, and monitors provider enrollment processes utilizing payer system specifications for MHMR billable providers, utilizing electronic enrollment when available.

1. Identifies MHMR billable providers and ensures all providers receive and complete enrollment documents within the scope of the MHMR Provider Enrollment Policy prior to hire.

2. Completes enrollment of all providers timely and accurately and develops and consistently maintains effective processes for monitoring provider enrollment status for all payer funding sources.

3. Consistently identifies and communicates all enrollment deficiencies effectively with Supervisor, Patient Financial Services and various interdepartmental teams and ensures all required provider information is entered and maintained in MHMR billing system(s).

1. Develops, implements, and monitors MHMR staff’s access to provider portals and payer systems following HIPAA Protected Health Information standards.

1. Accurately receives and processes MHMR staff requests for access to payer sites within the scope of staff’s position.

2. Accurately and timely creates staff log on, password and access rights to payer websites and communicates same directly to staff in a secure format (direct intra-agency e-mail.)

1. Processes correspondence requesting data necessary to complete requests, receives staff termination notices and terminates access on payer websites.

1. Remains in contact with program management to ensure enrollment and website access issues are addressed in a timely manner (within 2 days of receipt.).

2. Identifies deficiencies and requests data or clarification as above.

3. Processes corrections and terminations within 1 day of receipt.

4. Ensures effective resolution of all data and provider loading issues.

5. Maintains tracking reports for above processes including current status of all licensed and “billable” staff with timelines for measurable outcomes.

6. Submits tracking/status reports to Supervisor on a regular basis and addresses any problems or barriers.

1. Assists Supervisor in projects and other office duties as needed. This position will implement and maintain oversight over ongoing project logs and will regularly lead resolution of department projects.

1. Successfully completes all training as required by agency and/or supervisor.

2. Generates requested reports in MHMR and payer systems and credentialing software.

3. Analyzes output. Consults Supervisor with identified problems and aids in implementation of solutions.

4. Attends department staff meetings and other meetings as required by Supervisor.

5. Cross train in Enrollments, Credentialing and other PFS Department functions to be able to assist, as needed.

1. Performance standards are performed as applicable with MHMR’s We CARE values “We C*onnect People in Our Community. We Provide Access to Services. We Link People to Resources. We E*mpower People.”

2. Perform other job duties or responsibilities as requested or assigned.

III) Knowledge of Laws, Policies/Procedures, Skills, and Abilities

1. Knowledge of MHMR Policy and Procedures is necessary.

2. Knowledge of Payer’s Provider Enrollment Application processes Knowledge of HIPAA regulations.

3. Knowledge of computers, printers, agency software, and network system including word processing, spreadsheet applications, insurance industry internet and web-site processes including browser and upload procedures.

4. Knowledge of Medicare, Medicaid, Managed Care, Commercial 3rd Party billing and enrollment regulations.

5. Knowledge of the principles of all automated office equipment.

6. Knowledge of the basic office skills: business terminology, spelling, punctuation, grammar, arithmetic, and filing systems.

7. Basic knowledge of medical claims processing, CPT and ICD-CM coding.

8. Ability to communicate effectively in both written and oral formats.

9. Ability to establish and maintain effective working relationships with others and all levels of MHMRTC staff.

10. Ability to work independently on difficult or complex tasks and keeps accurate records.

11. Ability to take directions and follow instructions.

12. Ability to identify problems and propose solutions.

13. Ability to prioritize workload.

14. Type 35wpm

IV) Internal & External Customer Service

This position requires regular contact with other billing staff members, payer representatives, MHMR Credentialing office staff and providers of services. Contact is heavy with program staff and third party payer staff. This position reports to the Provider Enrollment Manager. The employee will accomplish this with above average written and verbal skills.

Job Requirements:

Job Type: Full-time

Pay: $20.50 - $22.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k) matching
• AD&D insurance
• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• Monday to Friday

Work Location: In person