ENROLLMENT SPECIALIST
Mercy Care

Atlanta, Georgia

Posted in Medical and Nursing


Job Info


Employment Type:
Full time
Shift:
Day Shift

Description:

POSITION SUMMARY: In this position, you will provide administrative and technical support for physician billing services. Provider enrollment support including preparing initial provider enrollment and re-enrollment forms required for insurance carrier participation. Communicate provider and site enrollment status to physicians and staff. Maintain records of all provider and site enrollment activities including all applications, application status and provider participation effective dates. Maintain up to date documents and credentials for all physicians and obtain updated documents as needed.

The Enrollment Specialist is responsible for obtaining and coordinating all necessary provider enrollment applications for billing to Medicare, Medicaid, Blue Shield, Champus, and various other agencies as assigned.

Core Responsibilities:

  • Maintaining deletions, additions, and changes to the physician maintenance file pertaining to physicians and to other pertinent information including quarterly review of group membership.
  • Handling telephone communication and written correspondence with providers, and fiscal intermediaries in an efficient and effective manner that facilitates the Provider Enrollment process.
  • Maintaining updated information on carrier requirements through contact with the carriers and by reviewing carrier bulletins, and other materials sent to the providers and from the Supervisor.
  • Working in a team effort on projects such as new start-ups for renewal, re-credentialing group applications as required by carriers by business changes such as Tax ID numbers and entities, or when directed by the Supervisor.
  • Reporting any problems, errors, and/or changes detected in provider enrollment requirements when discovered.
  • Preparing documents in a consistent and accurate manner. Requirements:
  • High school diploma+ Must have at least 2 years previous knowledge or experience with health care provider/physician credentialing, billing, and medical reimbursement.+ PECOS, CAQH, and previous online enrollment experience+ Previous experience in a business setting with fundamental clerical skills, preferably with medical or provider enrollment background+ Must be able to identify and proactively organize tasks to ensure completion within department timelines and goals+ Computer proficiency with intermediate MS Office skills+ Minimum of 45-50 WPM typing skills

*Provides patient care and/ or support activities appropriate to ages served; primarily adults ages 18-65 or geriatric patients ages over 65. May also include care for infant age 0-1-year, child ages 1-12 years or adolescent ages 13-17 years.

EDUCATION REQUIREMENTS: Minimum high school diploma or equivalent; Minimum 2-3 years of experience with credentialing and enrollment in a medical office or managed care setting and administrative support experience in a business office or preferably a health care environment. Preferred Associates Degree in Business or Health Care Administration or experience commensurate with education

EXPERIENCE REQUIREMENTS: Desired 2-5 years related healthcare and/or managed care credentialing experience. Preference given to Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) candidates. Must be 100% self-efficient with the ability to perform all tasks and manage responsibilities with little to no instruction or oversight from the supervisor.

JOB KNOWLEDGE: Strong skills in organization, prioritization, and communication are essential. Self-motivation and the ability to work with minimal supervision are expected. Also expected are: (1) discretion in handling confidential information (2) computer competence about database management and Microsoft Office products (3) excellent written and oral communication skills (4) strong interpersonal skills for interaction with administration, staff members, providers, and outside parties.

PHYSICAL REQUIREMENTS: See attached Working Conditions and Physical Requirements Sheet

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.



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