Provider Enrollment Specialist (R) - Integrative Emergency Services

IES is dedicated to cultivating best practices in emergency care, providing comprehensive acute care services, creating value, and supporting patients, employees, clients, providers, and physicians in pursuit of the highest quality health care.

Although work can be performed remotely, applicants must reside in a state we operate in: AZ, CO, TX, OK, IN, AL, SC, FL

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following.  Others may be assigned.

• Completes CAQH applications for new and existing providers. Will maintain CAQH reporting and attest provider applications every 120 days.
• Following established enrollment procedures and sound practices directly or by working with Enrollment Coordinators.
• Prepares applications for new providers for multiple contracts sites, payors, and states requiring an acute attention to detail, accuracy and knowledge of complex and varied requirements.
• Submit applications electronically to payors based on contracts. Track and follow up on a timely basis to ensure completion of application process and submission to payor for approval.
• Extensive and frequent verbal and written communications with Clinicians, state payors, insurance carriers, third party billing company and internal company staff requiring professionalism and tact to attain or provide all needed information quickly in order to expedite the enrollment of Clinicians in the various plans to maximize billing opportunities.
• Acts proactively and builds strong relationships with payors to facilitate enrollment and obtain provider billing numbers.
• Utilizes templates or prepares correspondence inserting proper provider and group related information for submission of applications to payors.
• Works with in-house and third-party Billing Company for current applications, system updates and identifying/resolving problems. Handles corrections or rejections of claims due to enrollment errors and/or claim submission requirements.
• Conveys issues and status of problems to Enrollment Manager. 
• Ensures Held A/R enrollments are submitted on timely basis to avoid risk of claims/adjustments and an unnecessary increase of Held AR. Maintain and work reports of held A/R to maximize income opportunities.
• Accountable for meeting or exceeding divisional and/or corporate Enrollment performance standards and meeting time-sensitive deadlines as defined. 
• Update status of application in system databases and in excel reports for accurate reporting.
• Works independently within the scope of responsibility and authority. Understands and follows state and payor requirements, some of which are quite complex, and determines which applications require management approval or special processing requirements.
• Able to work with high volume enrollments while multi-tasking and driving provider enrollments through completion.
• Assist and maintain enrollment reporting for different payors including Superior Health, Healthscope, and Cigna.
• Will work and assist with the Enrollment Master Reports and track application submissions, re-validations and re-enrollment for all providers and groups.
• Will support operations in states including, but not limited to, Florida, Texas, and Arizona
  • Florida plans include: Medicare, Medicaid, RR Medicare, Tricare, Florida Blue, United, Oscar, Cigna, Physicians Care Network IPA, West Florida, etc
  • Texas plans include: Medicare, Medicaid, RR Medicare, Tricare, BCBS, United, and 2 different PPN plans 
• Adheres to all company policies and procedures.

QUALIFICATIONS

Knowledge, Skills, Abilities:  To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Excellent analytical, organizational, and verbal/written communication skills.  Strong telephone skills.
• Ability to manage multiple priorities with high attention to detail within a high volume fast paced environment
• Strong customer service orientation
• Ability to use discretion appropriately and maintain confidentiality
• High levels of proficiency with MS Office applications, especially Microsoft Word and Excel
• Ability to read, write and speak English proficiently

Education / Experience:  Include minimum education, technical training, and/or experience preferred to perform the job.

Required:

• High School Diploma
• 3-5 years previous provider payor enrollment (individual provider and group enrollment) or related experience
• Ability to obtain, set-up, maintain, and reattest CAQH profiles
• Prior government healthcare payor experience

Preferred:

• Bachelor’s degree
• Enrollment experience with both Commercial and Government Plans 
• Multi-state Enrollment Experience 

PHYSICAL DEMANDS:  The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Specific vision requirements include the ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus
• While performing the duties of this job, the employee is regularly required to talk and hear
• Frequently required to stand, walk, sit, use hands to feel, and reach with hands and arms
• Possess the ability to fulfill any office activities normally expected in an office setting, to include, but not limited to:  remaining seated for periods of time to perform computer based work, participating in filing activity, lifting and carrying office supplies (paper reams, mail, etc.)
• Occasionally lift and/or move up to 20-25 pounds 
• Fine hand manipulation (keyboarding)

WORK ENVIRONMENT:  The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Work can be performed remotely 
• Must reside in a state we operate in - AZ, CO, TX, OK, AL, IN, SC, FL
• The noise level in the work environment is usually low

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

The company is committed to creating a diverse, inclusive, and equitable environment and is proud to be an equal opportunity employer. Qualified applicants of any age, race, religion, nationality, sexual orientation, gender identity or expression, disability, or veteran status will receive equal consideration for positions. We welcome people of diverse backgrounds, experiences, and abilities and believe that the unique experiences of our team drive our success.

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