Provider Enrollment Specialist
Company: Galveston County Health District
Location: Texas City
Posted on: May 26, 2023
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Job Description:
Coastal Health & Wellness is seeking a Provider Enrollment
Specialist!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 payors. Facilitates all aspects of
provider enrollment, including initial enrollment, re-enrollment,
monitoring, and appointment for medical, dental, and behavioral
health providers. Assists with problem identification and timely
resolution of payor related issues surrounding claim submission and
denial management to ensure optimal reimbursement. Position serves
as the liaison between managed care plans, payer population health
incentive measure and attribution list management, and CHW,
including Revenue Cycle Operations to resolve any billing issues
related to provider enrollment and promote optimal reimbursement.We
can offer you:Excellent benefits; including an amazing retirement
package, paid time off plans, FREE life insurance, FREE long-term
disability, Affordable medical insurance, FREE parking and much,
much more!Team Oriented EnvironmentSalary Rate: Commensurate with
ExperienceWe want you to join our current team of professionals and
continue a long-term career with us! If you meet the criteria
listed below, please apply.Required:Bachelor's degree in health
care administration, or related field of study or equivalent
industry experience.3 + years in a healthcare or health insurance
setting performing registration, back-office support, care
management, quality or health analysis required.2 + years of
experience and/or training in revenue cycle (health insurance plans
and benefits structures) preferred.Completion of technical
training/certification in a related field (such as Certified
Medical Assistant), preferred.Knowledge of CPT codes and basic
medical terminology (preferred).Phone communication
skills.Bilingual ability (English/Spanish) a plus.Must possess or
ability to readily obtain a valid driver's license issued by the
State of Texas for the type of vehicle or equipment
operated.Excellent written and verbal communication skills
required.Proficient in Microsoft Office (Word, Excel, PowerPoint)
required.Must be willing and able to work evening and weekend hours
if necessary.Must follow GCHD Immunizations policy.Must follow ICS
training requirements.Must pass criminal background check and
drug/alcohol screening.An equivalent combination of education and
work experience which appropriately demonstrates the knowledge,
skills and abilities to perform the above described essential
functions will be considered when hiring for this role.Job Specific
Functions:Facilitate enrollment of new CHW providers to ensure
proper and timely billing and collections.Prepare enrollment
applications for all health plans including Medicare and
Medicaid.Complete data entry and processing of enrollment
applications, with validation of provider submitted information to
ensure the application is complete, accurate, and meeting CHW
standards.Obtain licensure, certification, and insurance
certificates at time of enrollment and maintain in database in
order to submit with enrollment applications.Maintain timelines on
enrollment processes, and address and/or escalate any delays.Ensure
that all pending enrollments are reviewed, obtained, and managed
according to the rules and policies of the department.Provide
monthly notification of new providers, resignations, and changes in
provider status such as practice locations and panel status to
contracted plans.Follow up with necessary contacts, including
providers and managed care organizations, to resolve enrollment
application issues and deficiencies.Facilitate resolution of
provider related denials to ensure appeal procedures are followed
to result in proper reimbursement.Demonstrate a level of competence
and understanding of all state and federal laws, rules, and
regulations according to payer guidelines for billing.Respond to
internal and external inquiries on routine enrollment and contract
matters, as appropriate.Perform detailed follow-up activities on
assigned accounts according to procedures.Maintain confidentiality
of all provider enrollment business/work and medical staff
information.Participate in special projects/assignments.Read all
announcements and relevant communications relating to job
duties.Successfully complete competency-based training and
testing.Performs statistical and data analysis, benchmark
determination, goal setting, written and graphical reports and data
presentations of data for population health management programs
(UDS Measures, HEDIS, Medicare STARS, CCO metrics, quality
management/improvement).Ensures process and formation flow of all
population health data. Analyzes impact of data on various quality
improvement projects or programs.Performs gap analysis of current
systems to determine compliance with data reporting
requirements.Collaborates with other departments as necessary to
conduct and complete analyses.Attends internal and external
meetings to present analyzed data.Coordinates work associated with
payer incentive agreements.Facilitates payer incentive payments and
ensures they are received.Knowledge of CPT, (Evaluation &
Management, E&M) and ICD-10 codes (in addition, SDoH
Z-Codes).Assists, support and collaborates with the CHW
Credentialing Coordinator on all credentialing needs.Performs other
duties as assigned by supervisor.No Phone Calls
PleaseADA/EEO/DFWPOur Mission: Protecting and Promoting the Optimal
Health and Well-Being of Galveston County
Keywords: Galveston County Health District, Texas City , Provider Enrollment Specialist, Other , Texas City, Texas
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