Enrollment Specialist

Enrollment Specialist

U.S. Medical Management (USMM) is an affiliate of a leading Fortune 100 company. A national organization built on a continuum of care with premier healthcare providers, clinicians and patient focused individuals working together. Our Mission – “Through Compassionate Patient-Centered Care in the Home; We will Provide Exceptional Outcomes across our Continuum of Services” – Visiting Physicians Association, Pinnacle Senior Care, Grace Hospice, Comfort Hospice, Home DME & our In Home Health Assessments (IHA).

Our Values of Integrity, Respect, Teamwork & Excellence are leading us to a better tomorrow for patient care. Our Purposes Centered on “We are Unified in our Work through our Continuum of Services” “We can Find Comfort that We are Making a Difference for our Patients” & “We make a Broader Positive Impact on Society”, allows USMM to be poised for a phenomenal future.

We are seeking candidates who desire the experience of delivering quality & compassionate healthcare within proven care models with patients at the forefront of everything we do.

Benefits We Have to Offer: 

  • Health, Dental, Vision, Disability & Life Insurance
  • 401K Retirement Plan
  • Paid Holidays
  • PTO 
  • Flexible Spending Account
  • Tuition Reimbursement

Position Description

The Enrollment Specialist is responsible for provider and group health plan enrollment duties encompassing collecting appropriate documents, verifying sensitive provider data, and maintaining CAQH and credentialing databases.

Essential Duties and responsibilities

  • Maintain strict confidentiality of practitioner, company and personnel information
  • Gather, track, process newly hired practitioner’s and group enrollment documents 
  • Submit and oversee practitioner enrollment with government and commercial payors for activation and deactivation
  • Maintain practitioner’s CAQH profile including revised address updates and expired documentation
  • Collaborate with Credentialing, Billing and IT teams for seamless practitioner onboarding
  • Assist with EFT/EDI/ERAs for initial enrollment as applicable
  • Create and maintain practitioner electronic files including all documents for enrollment submission
  • Manage group and practitioner’s attestations and required documents, uploads in CAQH and credentialing database
  • Escalate practitioner adverse actions or enrollment issues to Credentialing and Enrollment Manager
  • Responsible for state fingerprinting requirements as specified with the applicable Board of Medicine guidelines
  • Communicate to key stakeholders updates regarding clinical practice sites (office relocations, facility revisions, and new facility start-up)
  • Maintain the credentialing database tracking for group and practitioner address revisions, terminations and communicate changes with teammates
  • Collaborate with Billing and Denial Management for claim denials related to enrollment issues
  • Provide multiple practitioner reports including but not limited to health plan enrollment statuses, practitioner count at each location and board certification specialties
  • Performs miscellaneous job-related duties as assigned

REQUIRED Knowledge, Skills and Experience

  • Bachelor’s degree or equivalent education and work experience
  • Two or more years of experience working in a managed care, hospital, or medical office environment
  • Two or more years of experience of provider multi-state credentialing
  • Maintain high-level confidentiality to sensitive data, HIPPA, etc.
  • Ability to research and maintain multi-state primary source verification and on-going monitoring
  • Clear understanding of provider malpractice insurance state requirements
  • A clear understanding in Microsoft Excel and Outlook
  • Strong attention to detail, accountability, organizational and interpersonal skills
  • Ability to multi-task and work independently
  • Ability to work in a fast-paced environment and prioritize duties
  • Strong accountability to a team environment
  • Excellent communication and organizational skills, verbal and written (end-user support documentation, policies, and procedures, etc.)

Preferred Knowledge, Skills and Experience

  • Experience in IntelliCred software
  • PECOS Applications
  • NPPES Website

Posted
01/02/2022
Type
Full time
Salary Range
$25,000.00 - 37,000.00
per Year
Salary range estimated by
Location
Troy, MI 48084, US
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