Job Purpose
The Provider Enrollment Associate is responsible for credentialing/enrolling new and established health care providers and maintenance of required information.
Duties and Responsibilities
- Communicates with providers to explain process and sign applications
- Collects, updates, maintains necessary provider information and documentation and verifies the information where possible
- Establishes and maintains data entry in CAQH
- Prepares provider enrollment applications for all initial applications and re-credentialing in a timely and complete manner
- Verifies provider and group information with insurance companies (addresses, contracted plans, provider ID numbers, etc.)
- Coordinates information for enrollment and termination of all providers
- Handles enrollment with Medicare, Medicaid, commercial insurances
- Contributes to the departmental process and procedures with a collaborative approach
- Works department client WQ’s and smart feeds where applicable
- Maintains provider enrollment mailbox and completes actions and follow up
- Performs other duties as requested
- Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Understand and comply with Information Security and HIPAA policies and procedures at all times
- Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
Qualifications
- High School graduate or equivalent required
- Minimum two years of provider enrollment experience
- Knowledge of Microsoft Office Suite, Outlook, Excel, CAQH
- Billing knowledge and experience preferred
- Excellent verbal and written communication skills
- Strong interpersonal skills, ability to communicate well at all levels of the organization
- Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
- High level of integrity and dependability with a strong sense of urgency and results oriented
- Excellent written and verbal communication skills required
- Gracious and welcoming personality for customer service interaction
Working Conditions
- Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes.
- Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
- Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
- Work Environment: The noise level in the work environment is usually minimal.
Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.