Practice made perfect

Join Our Talent Network

Provider Enrollment Maintenance Representative in Knoxville, Tennessee, US at TeamHealth

Date Posted: 2/13/2020

Job Snapshot

Job Description

JOB DESCRIPTION OVERVIEW:

The Provider Enrollment Maintenance Representative is responsible for proactively completing all provider enrollment maintenance activities. This position is responsible for minimizing any lapses in clinician enrollment and write offs/holds related to maintenance activities. This position is responsible for verifying maintenance requirements, ensuring centralized payer library is current and communicating updates to management and colleagues.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Complete all maintenance activities including research, recording, communication & information sharing, submission, confirmation and follow-up
  • Maintenance activities include, but are not limited to:
    • Medicare & Medicaid re-validations
    • Re-credentialing for all payers
    • Creation and maintenance of CAQH practice and clinician profiles
    • Submission of clinician updates e.g. licensure and certificates of insurance to payers
    • Completion of any/all requests for data validation from payers and internal customers
    • Manage roster submission, review and data entry
    • Collaborate with colleagues to resolve enrollment related denials associated with maintenance
    • Collaborate with analyst and/or HCFS to proactively monitor enrollment status for payers that require claim activity to remain participating
    • Partner with Lead to communicate any application, roster or payer required form updates Application Generation software
    • Partner with Manager to communicate any payer maintenance activity updates required in the payer library
    • Occasional overtime and/or participation on special projects may be required
    • Other duties as assigned

 

Job Requirements

QUALIFICATIONS / EXPERIENCE: 

  • Ability to operate effectively in a fast paced environment
  • Demonstrate a systematic approach in carrying out assignments; methodical in planning and performing; effective prioritization required
  • Display a high standard of professional conduct to include punctuality, job consciousness and dependability
  • Perform with a high degree of accuracy; give meticulous attention to detail
  • Work harmoniously and effectively across all levels of the business; cooperate with others for the benefit of the organization
  • Communicate clearly, concisely, positively and professionally
  • Show genuine interest in continuous development in professional and technical skills
  • High school diploma or equivalent; some college preferred
  • One year of experience with health care or comparable industry

PHYSICAL / ENVIRONMENTAL DEMANDS:

  • Job performed in a well-lighted, modern office setting
  • Ability to work a flexible schedule and after-hours as needed with access to appropriate technology
  • Occasional travel by plane and/or car
  • Occasional lifting/carrying (10 pounds or less)
  • Occasional standing/bending
  • Moderate to high stress level
  • Prolonged sitting
  • Prolonged computer/PC work
  • Prolonged telephone use

This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, and fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions. Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.

DISCLAIMER:

Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.

#ZR