Overview
Provide direct enrollment support to clinical providers to achieve CAQH and Medicaid license updates and maintain provider enrollments throughout the provider’s tenure with USAP to receive optimal reimbursement from payers.
Job Highlights
ESSENTIAL DUTIES AND RESPONSIBILITIES (include but not limited to):
- Submit and process CAQH and license updates in multiple states as assigned by leadership.
- Maintain the accuracy of provider NPPES and CAQH accounts.
- Populate and prepare enrollment applications for providers that pertain to Medicaid license updates.
- Responsible for following up on outstanding enrollment information and/or paperwork from providers.
- Review provider applications for accuracy and completeness.
- Track and follow up on CAQH attestations and or license update applications with payers until provider enrollment or re-enrollment is completed.
- Responsible for provider file maintenance with the payers, including but not limited to provider name changes, license updates, required attestations and any other payer required data.
- Establish and maintain professional working relationships with billing staff and work as a team to resolve billing issues related to enrollment in a timely manner.
- Work reports that identify enrollment issues distributed by leadership.
- Complete reports provided by leadership by assigned deadlines.
- Notify billing and appropriate key employees once provider numbers are received.
- Assist with roster reconciliation projects with payers.
- Demonstrate exemplary customer service to our payers, providers and other USAP employees.
- Meet targeted enrollment deadlines.
- Communicate risk to leadership as soon as identified.
- Consistently meet USAP set work standards.
- Proficiently use the USAP credentialing system as instructed by leadership.
- Maintain the USAP credentialing database as it pertains to enrollment.
- Contribute to the advancement and growth of the department.
- Proficiently use the USAP billing system as instructed by leadership.
- Communicate and work with the billing dept to resolve billing issues.
- Performs other duties as requested.
REPORTING TO THIS POSITION: No direct reports
JOB REQUIREMENTS (Knowledge, Skills and Abilities):
- Knowledge of organization’s policies, procedures and systems.
- Have a working knowledge of the enrollment process and requirements.
- Knowledge of Medicare and Medicaid enrollment standards.
- Knowledgeable with NPPES website and NPI accounts.
- Skilled in computer applications including MS Word, MS Excel, database administration and scanning applications.
- Have excellent customer service skills.
- Have strong organizational and time management skills.
- Ability to be flexible to change and growth.
- Ability to work effectively in a fast paced, high volume environment.
- Demonstrate ethical problem-solving skills.
- Skilled in professional verbal, written and email communications.
- Ability to work effectively with staff, physicians and external customers.
- Ability to work independently with limited supervision.
- Communicate professionally with the public.
- Ability to independently and consistently execute job responsibilities within a reasonable timeframe.
- Ability to read, write, and speak English
Qualifications
EDUCATION/TRAINING/EXPERIENCE:
- High School graduate or equivalent. AS or B.S. degree in business administration or health care related field is a plus.
- Two years of enrollment experience including Medicare and Medicaid experience.
PHYSICAL REQUIREMENTS:
- Requires prolonged sitting, some bending, stooping and stretching
- Must possess sufficient eye-hand coordination/manual dexterity to operate a keyboard, photocopier, telephone, calculator and other office equipment
- Required normal range of hearing and eyesight to record, prepare, and communicate appropriate reports and evaluations.
- Requires lifting papers and boxes weighing up to 35 pounds occasionally
- Requires dexterity to type at least 35 wpm.
WORKING CONDITIONS (environment and safety):
- Work performed in office environment.
- Involves frequent contact with colleagues, clinical providers, and hospital medical staff service departments.
- Work may be stressful at times.
- Interaction with others is frequent and often disruptive.
disclaimer: The above job description has been written to indicate the general nature and level of work performed by employees within this classification. It is not written to be inclusive of all duties, responsibilities and qualifications required of employees assigned to this job.
US Anesthesia Partners, Inc. provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, gender identity, sexual orientation, pregnancy, status as a parent, national origin, age, disability (physical or mental), family medical history or genetic information, political affiliation, military service, or other non-merit based factors.
