Provider Enrollment Representative

Silver Spring, MD, United States

The Provider Enrollment Representative will facilitate activities from the point of the provider candidate's acceptance of employment to the point of the candidate's approved enrollment with DC, Maryland, Virginia and West Virginia Medicaid and Medicare. The purpose of this position is to provide an efficient process to ensure that our new providers are enrolled prior to activation of privileges. The representative will work in concert with Medical Staff Services, the individual providers, department administrators and leadership to complete the enrollment applications and submit with all related credentials, licensing and other payer specific requirements. The Provider Enrollment Representative is a critical member of the Revenue Cycle and CNH organization teams for ensuring that providers are enrolled and prepared to begin working by the time of Board approval.

Qualifications:

Minimum Education

High School Diploma or GED (Required)

Associate's Degree (Preferred)

Minimum Work Experience

3 years Experience in customer service in a healthcare setting, professional billing or denial resolutions based on in-network and provider enrollment requirements

(Required) Or

3 years Experience in provider medical licensing and State and Federal enrollment processes and applications. (Preferred)

Required Skills/Knowledge

Superior ability to interface effectively with providers, provider leadership, internal departments and external agencies.

Superior administrative skills to include strong organizational skills and the ability to multi-task.

Extreme attention to detail and ability to focus and perform without supervision.

Superior communication skills both written and oral.

Internet and computer skills to include intermediate Excel and Word

Knowledge of healthcare and professional provider services

Functional Accountabilities

Documenting accepted and eligible provider

Partner with Medical Staff Services to ensure capture of the new onboarding providers and identify those that are eligible for enrollment.

Partner with Medical Staff Services to ensure that the CNH credentialing system is open for documenting enrollment activity and provider status

Create and maintain accurate and detailed Excel rosters with required data to share, record, track and follow-up for enrollment activity

Create and maintain archive files for storage and audit.

Provider License and Credential Activities Research for and coordinate licensure activities with MSS and the provider for the three jurisdictions for licenses, controlled substance certificates and DEA registrations and internally for the certificate of insurance.

Follow-up for missing or delayed credentials and license documents within the defined timelines.

Follow defined process and timelines escalating problems to the provider, department administrator and leadership for problems that will prohibit enrollment applications from filing within the expected time frames.

Enrollment Activities Following defined payer guidelines create individual provider accounts with state and federal payers.

Following defined payer guidelines complete online applications for DC, Maryland, Virginia and West Virginia Medicaid and within the required time frame.

Following defined CMS guidelines complete PECOS and/or online application for Medicare and within the required time frame.

Coordinate the required supporting documents with the application as defined by state and federal requirements.

Document and track submission of the application to ensure receipt by the payer

Working with the provider research and resolve license, data or NPPES registry problems related to denied or rejected applications within the required time frame.

Communication/Team Team with Business Operations, Medical Staff Services, Managed Care, the individual provider and department leadership to communicate enrollment activity and related problems and work together to resolve while providing superior customer service and communication.

Exhibit superior customer service and communications to providers, division chiefs and management

Partner with insurance companies to problem solve application or system related problems.

Supporting Enrollments Participate in projects related to payer changes and annual maintenance of provider enrollments new and established.

Participate in projects related to resolving established provider enrollment problems

Organizational Accountabilities

Organizational Accountabilities (Staff)

Organizational Commitment/Identification Anticipate and responds to customer needs; follows up until needs are met

Teamwork/Communication Demonstrate collaborative and respectful behavior

Partner with all team members to achieve goals

Receptive to others' ideas and opinions

Performance Improvement/Problem-solving Contribute to a positive work environment

Demonstrate flexibility and willingness to change

Identify opportunities to improve clinical and administrative processes

Make appropriate decisions, using sound judgment

Cost Management/Financial Responsibility Use resources efficiently

Search for less costly ways of doing things

Safety Speak up when team members appear to exhibit unsafe behavior or performance

Continuously validate and verify information needed for decision making or documentation

Stop in the face of uncertainty and takes time to resolve the situation

Demonstrate accurate, clear and timely verbal and written communication

Actively promote safety for patients, families, visitors and co-workers

Attend carefully to important details - practicing Stop, Think, Act and Review in order to self-check behavior and performance