Provider Enrollment Specialist

Shift Time: Monday-Friday 8 hours

Summary:

• Coordinates Medicare and Medicaid enrollment/re-enrollment and managed care credentialing and contracting processes for providers.
• Serves as administrator for billing system and assists practices with system issues.
• Maintains NPI files and provider numbers. Serves as customer service liaison.
• Monitors accounts receivable to maintain appropriate levels and reviews payments to maximize reimbursement.
• Interacts with patients, insurance carriers, the billing vendor and practice personnel concerning patient accounts.
• Performs all functions in a courteous and professional manner

Responsibilities:

• Collects and maintains data on providers for Medicare and Medicaid enrollment Prepares and submits applications to Medicare and Medicaid for new provider enrollments and existing provider updates
• follows up by telephone or in writing, with carriers regarding application status Complies with Medicare and Medicaid provider enrollment guidelines Requests NPI numbers for providers and clinics as necessary and maintains NPI files Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and/or appeals Generates various reports to identify outstanding claims issues with provider numbers and non-payment Communicates information to appropriate personnel Educates staff on corrections, e.g.. front-end entry errors in a positive, constructive manner
• Collects and reviews managed care contracts for correct billing and payment terms Identifies problem accounts and follows through to completion Reviews Athena correspondence and unportable