Provider Enrollment Specialist

Ventra Health

1 - 4 years

1 - 5 Lacs

chennai

Posted:3 days ago| Platform:

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Skills Required

providing hipaa health insurance us healthcare claims adjudication admissions claim payment enrollment healthcare counselling claims processing operations denial management claims medical billing admission counselling revenue cycle management student counseling

Work Mode

Work from Office

Job Type

Full Time

Job Description

Overview

The Provider Enrollment Specialist works in conjunction with the Provider Enrollment Manager to identify Provider Payer Enrollment issues or denials. This position is responsible for researching, resolving, and enrolling any payer issues, utilizing a variety of proprietary and external tools. This will require contacting clients, operations personnel, and Centers for Medicare & Medicaid Services (CMS) via phone, email, or website

Responsibilities

Performs follow-up with market locations to research and resolve payer enrollment issues
Performs follow-up with Centers for Medicare & Medicaid Services (CMS), and other payer via phone, email or website to resolve any Payer Enrollment issues
Manages the completion and submission of CMS Medicare, State Medicaid and any other third-party payer applications
Performs tracking and follow-up to ensure provider numbers are established and linked to the appropriate client group entity and proper software systems
Maintains documentation and reporting regarding payer enrollments in process.
Retains records related to completed CMS applications
Establishes close working relationships with Clients, Operations, and Revenue Cycle Management team
Proactively obtains, tracks, and manages all payer revalidation dates for all assigned groups/providers as well as complete, submit, and track the required applications to maintain active enrollment and prevent deactivation
Maintains provider demographics in all applicable enrollment systems
Adds providers to all applicable systems and maintains information to ensure claims are held/released based on status of enrollment
Performs special projects and other duties as assigned

Qualifications

Associate's degree (2 years), required and Bachelor's degree in any related field, preferred.
At least one (1) year of provider enrollment experience preferred.

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