Summary of Position:
Under the direction of the Director of Billing, the Payer Enrollment Specialist (PES) is responsible for the coordination, completion and submission of initial and recurring provider enrollment applications with Medicare, state Medicaid programs and all commercial insurance plans for all health center providers in a range of specialties. The PES is also responsible for maintaining accurate records, updating and amending applications as information changes including but not limited to, the additions and deletions of individual provider enrollments to the medical group’s applications as necessary, submitting updates in provider credentials, demographics, physical address, and other information as requested by all health plans.
- Research and coordinate requirements for provider/group enroll in Medicare, various state Medicaid and commercial health plans and identify issues that may present with enrollment such as, determining minimum criteria required for the enrollment of new and existing group providers, processing time, backdate requests, health plan backlogs, required group enrollment documentation, and payer timeframes for submission.
- Gather, validate and maintain updated practice related information required by payers.
- Prepare, review and submit all group/individual enrollment applications and revalidation documents.
- Communicate with payer representatives regarding additional information requests, which may involve educating such representatives on the nature of services provided by health center practitioners and the applicability of certain requirements
- Communicate with billing regarding assignment priority, as needed, and assist with claims rejections based on improper provider or group enrollment.
- Report status of pending enrollment applications to the Director of Billing and various health center personnel as applicable.
- Other duties as assigned.
- High school diploma or equivalent.
- 2 year Business or Healthcare Administration degree or related field from an accredited institution preferred.
- 1-3 years of experience in medical and behavioral health contracting and payer enrollment preferred.
- Knowledge of and experience working with Medicare, Medicaid and third party payers.
- Proficiency in Microsoft Office applications.
- Strong written and verbal communication skills.
- Task oriented, ability to prioritize and excellent organizational skills.
Fairfield Community Health Center's (FCHC) goal is high quality, better care for our patients. We have been recognized as a level 3 (the highest rating) Patient Centered Medical Home (PCMH) by the National Committee on Quality Assurance for all of our family practice offices. PCMH means that we offer a team approach with the patient being the most important member of the team. FCHC offers improved access to care with extended hours, as well as same and next day appointments. We work with specialists and hospitals to coordinate care to be sure that the entire healthcare team is working together to assure the best possible health for our patients. Please visit our website to learn more about Fairfield Community Health Center at www.fairfieldchc.org.
Location/Region: Lancaster, OH (US)