Provider Enrollment Specialist

JOB SUMMARY:

This position is responsible for completing all applications for payer plans for purposes of billing and reimbursement for health care services. This includes incorporation of information gathered from the credentialing process. The Provider Enrollment Specialist is responsible for coordinating, monitoring and maintaining the provider enrollment and re-enrollment process in a timely and compliant manner with all government and commercial plans.

DUTIES PERFORMED:

• Greets patients, staff and visitors in a pleasant and professional manner.
• Serve as the liaison for troubleshooting any provider or organization enrollment issues.
• Keep the Revenue Cycle Director informed at all times of the status of new/revised or pending physician and non-physician provider numbers, effective dates, and plan enrollment to prevent delayed claims filing and disruption to cash flow.
• Develops databases and spreadsheets for tracking the organization's provider enrollment.
• Accurately maintain all internal systems with appropriate provider and network participation information.
• Complete appropriate steps for updating and maintaining Provider Enrollment Databases to ensure claims are processed timely and accurately.
• Serve as a member of the Revenue Cycle Management Committee.
• Assist other staff in the resolution of provider enrollment issues.
• Complete and review applications for all new providers for assigned organizational contracts with various plans.
• Maintain CAQH profiles for individual providers when granted access by said provider.
• Ensure all work is performed in accordance with established policies and procedures.
• Prepare and process provider enrollment applications and organization enrollment applications for Medicare, Medicaid, and other payers.
• Track and follow-up to obtain provider numbers.
• Build knowledge base for payer requirements and forms.
• Obtain required credentialing paperwork from the HR Department.
• Maintain organized and accurate files for efficient and effective enrollment tracking to ensure credentialing information is obtained for all physician and non-physician providers to be included in enrollment and re-enrollment applications.
• Coordinates delivery of provider applications to appropriate health plans.
• Submit applications to payers.
• Utilize the available portals of various payers as necessary to complete the enrollment process.
• Follow-up and check status of applications with payers until provider and/or organization enrollment is completed.
• Attends all in-service training as required.

QUALIFICATIONS:

• EDUCATION:

• REQUIRED:

• Minimum of an Associate degree in Healthcare Administration, Business Administration, or related field

• EXPERIENCE:

• REQUIRED:

• Minimum of two years' experience in provider enrollment, revenue cycle management or provider credentialing

• OTHER REQUIREMENTS:

• Knowledge of insurance regulation and compliance.

• Experience with PECOS and the utilization of the SC Healthy Connections portal.

Benefits and Perks:

New Horizon Family Health Services offers a robust and comprehensive benefit package to full time employees.

• Automatic:

• Annual Leave

• Sick leave

• Up to 12 Paid Holidays plus your birthday

• Eligibility for 2 annual bonuses after 1 year of employment when defined eligibility criteria are met

• Continuing education courses through SC AHEC

• Various employee discounts. I.e., Verizon, AT&T, YMCA, etc.

• Eligibility for the Public Service Loan Forgiveness (PSLF) Program

• Optional:

• Medical (PEBA State Health Plan), Dental and Vision benefits

• Flexible Spending and Health Savings Accounts

• Voluntary Life Insurance

• Short Term Disability and Long Term Disability

• Accident and Critical Illness Coverage

• 403 (b) Retirement Plan, with up to 4% employer match after the first year of employment

Mission:

Our Mission is to provide quality, affordable, compassionate patient-centered health care to improve the health of the communities we serve. Our Vision is that our community will be one of the healthiest in the Nation. Superior patient care is the hallmark of NHFHS.

ICARE Values:

The ICARE values of New Horizon Family Health Services guide our employees toward achieving the mission of our company and our vision for our community. Our values stand for Integrity, Collaborations, Accountability, Respect, and Enrichment.

Community:

Greenville, South Carolina is the perfect place to live, work, and play. Greenville is surrounded by mountains, lakes, hiking & biking trails, as well as recreational activities including golf, tennis, water sports, cultural performances and more. Geographically located between Atlanta, GA and Charlotte, NC, with beaches just 3.5 to 4 hours away.

We are an Equal Opportunity employer.