Provider Enrollment Specialist

Job Title: Provider Enrollment Specialist 

Department: Medical Staff Services  

Reports To: Medical Staff Services Manager, Administrative Assistant

FLSA Status: Non-Exempt

Hours: 40/week

Shift: Days, Monday through Friday

JOB DESCRIPTION

The Provider Enrollment Specialist is responsible for organizing, maintaining, and verifying all aspects of the provider enrollment process for physicians and FCMC facilities, while upholding high-quality standards. The duties listed below are intended only as illustrations of the various types of work performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to this job.

• Complete and submit detailed enrollment forms to commercial insurers, Medicare, and Medicaid. 
• Work directly with insurance companies to track progress, answer questions, and resolve delays.
• Keep provider databases updated with current licenses, certifications, NPI numbers, and practice locations.
• Manage periodic re-enrollment and revalidation requirements to prevent lapses in billing status.
• Research and fix billing rejections caused by enrollment or network status errors. 
• Maintain and ensure that payer enrollment information is complete, accurate, and up-to-date for all active EHR systems for physicians and facilities
• Maintain physician and facility attestations and consent forms with significant payers, networks, and databases 
• Provide payers and networks with the requested documentation on physicians and facilities
• Coordinates with payers and networks available in our area and the surrounding areas. 
• Maintains confidentiality by protecting sensitive, proprietary, or confidential information. Adheres to HIPAA privacy and security requirements
• Protects patients and employees by adhering to infection-control policies and protocols
• Must wear Personal Protective Equipment (PPE) as required to maintain Infection Control Standards as set by the facility
• Performs other related duties as assigned

MINIMUM QUALIFICATIONS

• High School Diploma or GED equivalent required 
• 1-3 years' experience in a medical office, hospital administrative department, medical billing, or health insurance coordination or processes required 
• Understanding of medical terminology; familiarity with federal Provider Enrollment, Chain and Ownership System (PECOS); and experience navigating the CAQH Provider Data Portal is preferred 

ESSENTIAL JOB FUNCTIONS

• Regular and predictable attendance
• Regularly required to sit, bend, stoop, and stretch
• Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment
• Requires a normal range of hearing and eyesight to record, prepare, and communicate appropriate reports
• This job's specific visual abilities include reading and interpreting reports and data
• Prolonged periods sitting at a desk and working on a computer
• Must be able to access and navigate throughout the department within the organization's facilities 

WORK ENVIRONMENT

• FCMC operates 24 hours a day, every day of the year. The operational needs of departments may require you to be available to work all shifts, including weekends and holidays, to meet the needs of patients
• The employee generally works in typical office conditions, with a quiet noise level
• Occasional exposure to emotional or physical stress
• The employee works in the hospital setting
• May be required to travel to other facilities to obtain training as necessary