Billing, Corrective Action, Customer Support/Service, Data Quality, Demographics, Financial Management, Information/Data Security (InfoSec), Organizational Skills, Policy Development, Privacy Controls, Procedure Development, Safety Standards, Team Player, Time Management
Duties and Responsibilities
Essential Functions:
- Prepares and submits payer enrollment applications for providers and applicable entities, including initial, revalidation, updates, and terminations.
- Submits enrollment information through payer portals and required systems (e.g., CAQH and other payer-designated platforms) and documents all actions.
- Tracks enrollment submissions, follow-ups, provider numbers, and effective dates; maintains accurate enrollment status logs and records.
- Coordinates demographic, practice location, and billing updates with payers and internal partners to ensure data accuracy across systems.
- Communicates enrollment status and effective dates to practices, Revenue Cycle, and other stakeholders to support billing readiness.
- Works with payer representatives to resolve missing information, application rejections, and processing delays.
- Assists with identifying and resolving enrollment-related claim or billing issues by researching enrollment history and coordinating corrective actions.
- Runs routine enrollment reports (pending, effective dates, revalidation due) and initiates follow-up to meet timelines.
- Maintains confidentiality and complies with organizational privacy and information security standards.
Common Expectations:
- Maintains established policies and procedures, objectives, quality assessment and safety standards.
- Maintains professional growth and development.
- Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.