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Provider Enrollment Specialist in Woodbury, NJ at TeamHealth

Date Posted: 3/21/2019

Job Snapshot

Job Description

 JOB DESCRIPTION OVERVIEW:

The Provider Enrollment Specialist is primarily responsible for follow up with the carriers to ensure the application has been received, identify any deficiencies and help secure the provider numbers. Responsibilities include notifying billing center for reviewing, researching and resolving DMS (claim denials associated to Provider Enrollment issues)/provider hold issues each week.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

◊ Generate ‘Applications Sent to Carrier but not Effective’ reports from Teamworks

◊ Follow up with carriers and document in Teamworks

◊ Receives notification of provider number/effective date and PAR status(es)

◊ Completes, submits and documents stationery to billing center

◊ Works with corporate hold report, releases claims, identifies charge corrections and write offs (write offs must have approval of PE Director)

◊ Resolves DMS issues each week by researching and releasing claims, solving enrollment issues with payers and/or ensuring revalidation is complete

◊ Review weekly exception reports from management to prioritize critical issues

◊ Resolve deficiencies

◊ Delegates revalidations and re-enrollment to Provider Enrollment Coordinator when identified

◊ Research and reviews billing center inquiries about IDX and billing issues

◊ Train staff on Provider Enrollment processes

◊ Support Provider Enrollment Department

 

 

Job Requirements

QUALIFICATIONS / EXPERIENCE:

◊ HS Diploma or equivalent; Some college preferred;

◊ One year of experience with contracts, legal documents or other health care related work;

◊ Proficient in Microsoft Office applications;

◊ Meticulous accuracy;

◊ Ability to make decisions and solve problems;

◊ Excellent communication skills (verbal and written); Ability to communicate effectively with Providers, Medical Directors and VPOs;

◊ Excellent organizational skills with the ability to prioritize and manage multiple projects;

◊ Ability to meet challenging deadlines; ability to function in stressful situations;

◊ Ability to work in a team environment;

◊ Overtime may be required; Some training and seminar attendance may require overnight travel.

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.