Patient Account Associate
General Description of the Job Class
The Provider Enrollment (PE) Specialist is responsible for preparing and submitting enrollment applications and supporting documentation for the purpose of enrolling individual physicians, physician groups and hospitals. The PE Specialist researches and resolves billing issues related to Provider Enrollment. A variety of systems and external tools are utilized in order to research and resolve provider enrollment issues. The Provider Enrollment Specialist will be required to interact with Senior Management, Business and Revenue Managers and Operational Personnel.
Duties and Responsibilities of this Level
- Works closely with clinical departments on notification of a provider’s start date, welcome packets, provider documentation and ensuring the provider is in all systems.
- Researches and resolves bill holds related to provider enrollment.
- Updates billing system to define billing and service provider effective and termination dates, create payer specific bill holds, NPI and NPI subpart numbers, taxonomy codes and payer specific provider numbers. Removal of bill holds at the completion of enrollment by payer.
- Monitors and advises physicians and providers on license expirations.
- Performs follow-up with insurance payers via phone, email or website to resolve provider enrollment issues.
- Monitor the completion and submission of provider enrollment applications for individual providers, clinics and hospitals.
- Assign reminders and follow-up to ensure provider numbers are established and linked to the appropriate group entity in a timely manner.
- Understand specific enrollment requirements for each payer and provider type including pre-requisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.), and regulations.
- Maintain documentation of enrollment packets or spreadsheets related to enrolling Physicians and the present status of the packet.
- Work provider enrollment denial workqueues to ensure timely response for resolution and provide input to Supervisor on denials we can reduce.
- Establish close working relationships with provider enrollment packet contacts, contracting department, clinical departments, and payer contacts.
- Respond to internal and external inquiries on routine enrollment, as appropriate.
- Interfaces regularly with internal staff in A/R, Registration and Payer Relations.
- Maintain a strict level of confidentiality for all matters pertaining to provider credentials.
- Assists with a variety of special projects.
- Performs other duties as assigned.