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Provider Enrollment Specialist in Knoxville, TN at TeamHealth

Date Posted: 11/20/2019

Job Snapshot

Job Description

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

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.