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*Coordinator III

Conflux Systems, Inc.

Cumberland, RI

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JOB DETAILS
SALARY
SKILLS
Accounts Receivable, Administrative Skills, Analysis Skills, Billing, Call Center Operations, Communication Skills, Contract Management, Corporate Compliance, Data Analysis, Data Quality, Documentation, Government, Government Policies, Healthcare Providers, High School Diploma, Mail Processing, Maintain Compliance, Marketing, Medicaid, Medicare, Metrics, Microsoft Outlook, Operational Support, Operations Management, Organizational Skills, Past Due Accounts, Problem Solving Skills, Provider Relations, Regulatory Compliance, Regulatory Requirements, Team Player, Time Management, Trend Analysis
LOCATION
Cumberland, RI
POSTED
30+ days ago
Here are the job details for your review:     Job Title: Enrollment CoordinatorDuration: 10+ Months Contract (Potential for extension)Location: 200 Highland Corporate Drive Cumberland RI USA 02864Pay Rate: $24.99/ HR on W2shift times: Mon - Fri 7:30am - 4:00pm   PRESCREEN THAT NEEDS TO BE AT TOP OF EACH RESUME:
  • Location at tope of resume
  • Medicare experience? If yes, how many years of exp and a brief summary of exp
  • Medicaid experience? If yes, how many years of exp and a brief summary of exp
  • Brief summary of candidates excel experience
Notes from Spotlight Call:
  • Position Title: Enrollment Coordinator
  • Department: Payer Enrollment – Government Payers (Medicare/Medicaid)
  • Location: On-site required due to physical mail handling
  JOB DESCRIPTION: 
  • This position is responsible, under the supervision of the Manager of the Payer Enrollment Dept. to:
  • Ensuring timely and accurate processing of Payer Enrollment applications (Initial and Revalidations) for Clinics and Providers.
  • Provide quality control for timely and accurate individual enrollment applications submitted for Medicare and Medicaid programs.
  • Resolve claims issues for individual payers in corporate billing system.
  • Researching, completing and maintaining compliance with individual Government payers through credentialing, re-credentialing and audit processes and procedures.
  • Contact Providers when Revalidation notices are received in order to obtain signature pages and validate current general information. Interact with the field (SPM and CPM’s) in regards to escalation notices.
  • The Payer Enrollment Coordinator will be responsible for identifying and quantifying trends/issues and then effectively communicating them to the appropriate members of the management team along with what the potential impact could be.
  • Minimize denials and deactivation of government applications where applicable to reduce key metrics including DSO, cost to collect, percent of aged claims, and Bad Debt.
  • Update Credentialing and Billing systems with Provider information upon inquiry or receipt from Government /Commercial payers.
  • The Payer Enrollment Coordinator will be responsible for ensuring corporate compliance with statutory requirements for Medicare, Medicaid, and Commercial enrollment for Clinics and Providers.
  • This Individual will have the ability to work well with others; collaboratively with internal and external vendors and create partnerships through effective relationship building skills.
  • This role will interact and work directly with new and existing Government /Commercial payers across the country.
  • Analysis will include developing of provider and clinic level reporting insuring we are meeting all criteria for enrollment within our compliance policy for Government /Commercial.
  • Payer Enrollment Coordinator will interface and work directly with the Providers, and also with Payer Relations and Revenue Cycle Operations Teams (Credentialing, Accounts Receivable, Billing, and Call Center) Clinical Ops Teams, and MinuteClinic Field and Operations Management, in order to ensure integration of all processes.
  • Provides administrative and operational support to network management and provider relations functions. Assists with contract management, data analysis, provider directory maintenance, coordination of provider communication and education, and support of the resolution of operational issues.
  • Maintains accurate provider information, facilitating effective communication and ensuring smooth operations within the network management and provider relations department.
     
Key Responsibilities:
  • Submit initial and revalidation applications for providers entering MinuteClinics
  • Handle government payer enrollment (Medicare/Medicaid)
    Manage mail-based documentation and workflows
     
Ideal Candidate Profile:
Experience:
  • 1-3 years work experience with Government payers
  • Adept at problem solving and decision making skills
  • Ability to work independently
  • Proficient in Excel
  • Proficient in Outlook
  • Willingness to learn
 Soft Skills:
  • Reliable and consistent attendance
  • Willingness to work on-site
  • Strong communication and organizational skills
 Interview & Logistics:
  • Interview Format: Microsoft Teams (virtual)
  • Interview Timeline: 1–2 business days after resume review
  • Rounds: Single interview round
  • Pre-Screening: Required; candidates should note any relevant experience or lack thereof clearly
  Education:       
  • Verifiable High School diploma or GED required; Bachelors Degree in Marketing preferred

About the Company

C

Conflux Systems, Inc.