Enrollment Specialist

GetixHealth


Date: 1 week ago
City: Remote, Remote
Contract type: Full time
Remote
Job Details

Description

Responsibilities:

  • Enroll, Update and confirm group EDI/ERA/EDI enrollments through hard copies or payor portal.
  • Perform the initial provider enrollment and recertifying functions for employed and contracted practitioners. This may include collaborating with physicians, nurse practitioners, and Locum Tenens.
  • Maintain timely and accurate data entry and periodically revise practitioner data in the credentialing database; maintain practitioner electronic data files for practitioners; use the CAQH system to submit practitioner data as required by some client health plans to enroll individual practitioners.
  • Enroll practitioners with all appropriate client health plans; monitor and report on progress of each practitioner.
  • Enroll government payers using electronic method such as PECOS and payer portals.
  • Monitor expiring licensure, board and professional certifications and other expirable documents with practitioners within the prescribed time frames as outlined in the policies and procedures.
  • Identify, analyze and resolve extraordinary information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to enroll practitioners.

Requirements

  • Minimum of 2 or more years of experience in Health Care and Enrollment services.
  • Knowledge and understanding of payor portals to complete group and provider enrollments as well as EDI/EFT/ERA.
  • Familiarity with practitioner billing and claims payment system requirements as related to practitioner enrollment.
  • Requires exceptional critical thinking skills, sound judgment and the ability to communicate in an articulate manner with practitioners, administrators, and client credentialing personnel.
  • Experience with Microsoft Office and Excel
  • Prior use of common Credentialing Tracking Software, such as Verity or Modio

Preferred

  • Athena billing systems a plus
  • Prior experience with Medical Payer enrollment, Medical Staffing and Privileging.
  • Certification in Credentialing/Enrollment services.
  • Experience with National Committee for Quality Assurance, URAC and/or The Joint Commission guidelines and standards related to provider enrollment.

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