What are the responsibilities and job description for the Provider/Facility Payer Enrollment Specialist- (FT) position at Madison Memorial Hospital?
The Provider Payer/Facility Enrollment Specialist works in concert with the Medical Staff Services Manager to ensure all healthcare providers employed and contracted with Madison Memorial Hospital are in compliance with the payer credentialing requirements.
Full time
- Schedule: Monday-Friday 8am-5pm
- Benefit eligible
Required Skills:
1. Ability to communicate effectively with the public, as well as, all levels of hospital personnel. Must have organizational ability, and ability to communicate verbally and in writing.
2. Working knowledge of word processing and spreadsheet programs, such as, Microsoft Word, Excel, Access, PowerPoint, Internet, etc., along with general office equipment (calculator, fax, and copier).
3. Must have the ability to maintain confidential information.
4. Must be detail oriented.
5. Must have excellent reasoning ability and be able to think through processes.
6. Must have excellent customer service skills.
Minimum Work Experience:
1. Minimum of 2-3 years of experience in payer enrollment
Minimum Education:
1. Associates degree in related field
Position Duties:
- · Enroll all employed and contracted healthcare providers with the contracted health plans.
- · Perform timely monitoring and follow-up with carrier and providers on all applications. Submits payer applications within three (3) business days or fewer of Board of Trustees approval.
- · Ensure all employed and contracted healthcare providers/facilities maintain current enrollment and compliance with the contracted health plans.
- · Maintains and updates data on practitioners/facilities including, but not limited to: name changes, office location and demographic changes, collaborating or supervising MD updates/changes, linking practitioners to new groups, TINs, etc.
- · Completes maintenance updates and re-verification/re-validation for all practitioners/facilities within established timeframes. Including Medicaid/Medicare, CAQH and NPPES/PECOS accounts.
- · Maintain up to date knowledge of insurance health plans and agency requirements for credentialing providers/facilities.
- Works with billing department to resolve payer enrollment denial issues related to enrollment process.
- Demonstrates level of competence and understanding of all state and federal laws, rules and regulations according to payer guidlines for billing.
- Maintains a list of contacts with various payers
-
Maintains personal adherence to professional confidentiality standards, established within the department and in accordance with legal, ethical, and hospital policies.
