Provider Enrollment Specialist

Posted on 2018-08-21

Job Number0066100000P3zOgAAJ
Job LocationEast Tenn
Salary Range16.00/hr
PositionProvider Enrollment Specialist

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

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