Provider Enrollment Specialist at Della Infotech

JOB DESCRIPTION

• Collects and maintains data on providers for Medicare and Medicaid enrollment 
• Prepares and submits applications to Medicare and Medicaid for new provider enrollments and existing provider updates; follows up by telephone or in writing, with carriers regarding application status 
• Complies with Medicare and Medicaid provider enrollment guidelines 
• Requests NPI numbers for providers and clinics as necessary and maintains NPI files 
• Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and/or appeals 
• Generates various reports to identify outstanding claims issues with provider numbers and non-payment 
• Communicates information to appropriate personnel 
• Educates staff on corrections, e.g. front-end entry errors in a positive, constructive manner 
• Collects and reviews managed care contracts for correct billing and payment terms 
• Identifies problem accounts and follows through to completion
• Reviews Athena's correspondence and unpotable 
• Participates in company-sponsored enrollment/credentialing meetings and other educational activities 
• Participates in Billing System Training exercises and updates 
• Assists in training on the Billing System software package when necessary 
• Serves as a Superuser of the Billing System to be available to answer questions from the various clinics 
• Follows the CHRISTUS guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI) 
• Maintains strict confidentiality 
• Uses oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with the CHRISTUS Mission 
• Maintains established CHRISTUS policies, procedures, objectives, quality assurance, safety, environmental, and infection control.
• Implements job responsibilities in a manner that is consistent with the CHRISTUS Mission and Code of Ethics and supportive of CHRISTUS Physician Group’s cultural diversity objectives.
• Performs other related work as required.

QUALIFICATIONS:

• High School Diploma 
• 1-3 years of Payer Enrollment experience 
• Solid knowledge and utilization of PC applications to include WORD, EXCEL, ACCESS 
• Excellent written and verbal communication skills 
• Excellent organization and planning skills with demonstrated teamwork skills 
• Proven ability to interact with all levels of management and other Associates