Provider Enrollment Specialist

9126727 Provider Enrollment Specialist, Irving, TX, 3 months Contract
Sigma. Inc is currently looking for a Provider Enrollment Specialist to work onsite with our team located in Irving, TX.

Shift timings: Monday - Friday, 8 am - 5 pm, 40 hrs/week

Summary

• Coordinates Medicare and Medicaid enrollment/re-enrollment and managed care credentialing and contracting processes for providers.
• Serves as administrator for billing system and assists practices with system issues.
• Maintains NPI files and provider numbers.
• Serves as customer service liaison.
• Monitors accounts receivable to maintain appropriate levels and reviews payments to maximize reimbursement.
• Interacts with patients, insurance carriers, the billing vendor and practice personnel concerning patient accounts.
• Performs all functions in a courteous and professional manner

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 unpostables.
• Participates in company sponsored enrollment/credentialing meetings and other educational activities
• Participates in Billing System Training exercises and updates
• Assists in training on the Billing System software package when necessary
• Serves as a Superuser of the Billing System to be available to answer questions from the various clinics
• Follows the clients guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent or detect unauthorized disclosure of Protected Health Information (PHI)
• Maintains strict confidentiality
• Uses oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with the Clients Mission
• Maintains established clients policies, procedures, objectives, quality assurance, safety, environmental and infection control
• Implements job responsibilities in a manner that is consistent with the clients Mission and Code of Ethics and supportive of clients Physician Group's cultural diversity objectives
• Performs other related work as required Other Information

Education/Skills

• High School Diploma or equivalent
• 1-3 years of Payer Enrollment experience
• Solid knowledge and utilization of PC applications to include WORD, EXCEL, ACCESS
• Excellent written and verbal communication skills
• Excellent organization and planning skills with demonstrated teamwork skills
• Proven ability to interact with all levels of management and other Associates