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Provider Enrollment Specialist
Company: Schumacher Clinical Partners Salary Range:
Job Type: Full-Time Location: Lafayette, LA
United States
Company URL www.schumacherclinical.com/providers/corporate-careers


Job Description
The Provider Enrollment Specialist directly impacts the financial stability of the Company by representing Schumacher Group in the provider number approval process. The Provider Enrollment Specialist, using his/her knowledge of Schumacher Group policies in conjunction with insurance carrier credentialing and enrollment requirements, facilitates provider enrollment and billing privileges. This position is responsible the coordination of insurance plan enrollment and credentialing activities among various parties, including the Provider, Regional Operations staff, Insurance Carrier and Billing Company Representatives.

Job Description

Responsibilities:

Provider Enrollment

Process Medicare, Medicaid, BCBS and Managed Care (third party payors) applications simultaneous to hospital privileging process:
Collaborate with both regional Operations personnel as well as Providers directly to secure provider enrollment applications in a timely manner.
Process, complete and submit provider enrollment applications to the Insurance Carrier within specified timeframe to avoid write off of charges and maximize reimbursement
Participate on bi-weekly conference calls with Division and Regional personnel to address and strategize on outstanding enrollment issues
Provider’s Liaison to Billing Company on enrollment and claims related issues
Follow-up with insurance plans to secure provider approval through provider number (PIN) assignment. Enter approval information into Sales Force so billing company can be notified to release claims.
Managed Care Department Interaction
Work with SG Managed Care personnel to ensure timely enrollment with managed care plans to maximize reimbursement and minimize patient complaints related to participation status
Provider Enrollment Specialist has access to confidential and protected patient information and must handle sensitive information in accordance with SG protocol and HIPAA rules and regulation.
Monitor carrier website for forms revision and update master provider enrollment packets as needed
Advise management of issues with carriers/problem providers
Answer incoming calls in a professional manner
Maintain clear and concise Enrollment files both in paper form as well as Sales Force
Maintains a high degree of ethics, integrity, and confidentiality in dealing with employees, and external customers
Provider Enrollment Claims Resolution

Act as primary contact for Provider Enrollment regarding provider-related claim denials
Research and resolve provider-related claim denials by contacting payors and communicate results to appropriate Provider Enrollment Manager
Submit registration info via spreadsheet or form as needed for Medicaid HMO products and keep current
Document all registration submissions and notes in Sales Force
Review carrier and industry websites, newsletters, etc to assure thorough understanding of industry standards and changes
Any other duties deemed necessary by management
Knowledge, Skills, and Abilities:

Knowledge of Centers for Medicare and Medicaid Services (CMS), Council for Affordable Quality Healthcare (CAQH ) and National Committee on Quality Assurance (NCQA) credentialing requirements is preferred.
Manage multiple priorities and possess strong organizational skills
Overall working knowledge of software programs with a drive to incorporate technology in all operational functions
Ability to analyze data, make recommendations and implement plans
Results driven
Drives service and quality excellence
Ability to foster a cooperative work environment
Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community
Knowledge of web page access and utilization
Ability to communicate effectively both orally and in writing
Possess critical and strategic thinking skills


Contact Info
Contact Name:
Contact Company:
Contact Phone:
Contact Email:jobs@acadianashrm.org


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