Provider Enrolment Specialist

Requirements: Excellent written and verbal communication skills. Excellent organizational and planning skills with demonstrated teamwork and vendor management skills.3+ years of experience required in Medicare and Medicaid enrollment/re-enrollment and managed care credentialing and contracting processes for providers.

Responsibilities: Collects and maintains data on providers for Medicare and Medicaid enrollment. Prepares and submits applications to Medicare and Medicaid for new provider enrollments and existing provider updates; follows up by telephone or in writing with carriers regarding application status. Complies with Medicare and Medicaid provider enrollment guidelines. Requests NPI numbers for providers and clinics as necessary and maintains NPI files. Follows up, either by telephone or in writing, with insurance companies and patients regarding the processing of outstanding claims and/or appeals. Generates various reports to identify outstanding claims issues with provider numbers and non-payment. Communicates information to appropriate personnel. Educates staff on corrections, e.g., front-end entry errors, in a positive, constructive manner. Collects and reviews managed care contracts for correct billing and payment terms. Identifies problem accounts and follows through to completion. Reviews Athena correspondence and updates as necessary. Participates in company-sponsored enrollment/credentialing meetings and other educational activities. Participates in billing.