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Provider Enrollment Specialist in Pleasanton, CA at TeamHealth

Date Posted: 11/8/2018

Job Snapshot

Job Description

JOB DESCRIPTION OVERVIEW:

The Provider Enrollment Specialist is responsible for obtaining and coordinating all necessary provider enrollment applications for billing to Medicare, Medicaid, Blue Shield, CHAMPUS, and various other agencies as assigned. Functionally, these activities are key to the maintenance of the physician group, individual physician records, regulatory, and hospital contract compliance.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Prepare documents necessary for issuance of provider numbers for physicians and physician assistants.
  • Maintains deletions, additions, and changes to the physician maintenance file pertaining to physicians and to other pertinent information including quarterly review of group membership.
  • Handles telephone communication and written correspondence with providers, and fiscal intermediaries in an efficient and effective manner that facilitates the Provider Enrollment process.
  • Maintains updated information on carrier requirements through contact with the carriers and by reviewing carrier bulletins, and other materials sent to the providers and from the Supervisor.
  • Works in a team effort on projects such as new start-ups for renewal, re-credentialing group applications as required by carriers by business changes such as Tax ID numbers and entities, or when directed by the Supervisor.
  • Reports any problems, errors, and/or changes detected in provider enrollment requirements when discovered.
  • Prepares documents in a consistent and accurate manner.
  • Communicates information to input into the IDX System including new providers and updates of provider information using the appropriate forms.
  • Follows Team Health guidelines for preparing documents in a consistent and accurate manner.
  • Reports any detected problems, errors, and/or changes in provider enrollment requirements when discovered.
  • Understands and complies with Team Health Compliance Program.
  • Other duties as assigned.

Job Requirements

QUALIFICATIONS / EXPERIENCE/Education: 

  • Minimum high school diploma or equivalent.
  • Meticulous accuracy.
  • Effective oral and written communication skills.
  • Minimum of 45-50 WPM typing skills.
  • Computer literate.
  • Good decision-making, analytical, and problem-solving skills.
  • Ability to manage competing priorities.
  • Excellent customer service and ability to interact at all organizational levels.
  • Self-starter with ability to work independently and as part of a team
  • Must be able to identify and proactively organize tasks to ensure completion within PE Department timelines and goals.
  • Previous experience in a business setting with fundamental clerical skills, preferably with medical or provider enrollment background is preferred.
  • Possesses previous knowledge or experience with health care credentialing, billing, and medical reimbursement. PECOS and previous online enrollment experience a plus.

 

SUPERVISORY RESPONSIBILITIES:

  • NonePHYSICAL / ENVIRONMENTAL DEMANDS:
  •  
  • General office environment.
  • Job performed in a well-lighted, modern office setting;
  • Occasional lifting/carrying (10 pounds or less);
  • Prolonged sitting; with prolonged work in a computer/PC;
  • Occasional work in evenings and on weekends;
  • Moderate stress;
  • May require moderate overnight travel;
  • Overtime may be required and can be mandated by Management.
  • Ability to work well in fast-paced environment.

This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, 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:

 

The above information on this 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 job.

 

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.