Provider Enrollment Specialist

Job Posting Closing Date: Open until Filled

Where do you belong?

Your career is more than just a job, it's part of your life. Whether you’re a clinician, or non-clinical professional,  at USACS you'll feel a sense of connection working with clinicians and office staff who share your interests and values. We want you to love coming to work each day because you believe in what you do and the people with whom you work. We care about your success.

USACS also understands that location is important. We offer  career opportunities for clinicians and non-clinical support staff from New York to Hawaii and numerous points in between. Our supportive culture,  outstanding benefits and competitive compensation package is best in class.

Job Description

The Provider Enrollment Specialist is responsible for completing error-free and timely payer enrollment activities in support of clinicians joining USACS. The PE Specialist will work in partnership with clinicians, health plans, Credentialing, Legal, Finance and other internal departments to obtain required documentation to complete payor enrollment processes. This position requires a strong teamwork orientation, solid verbal & written communication skills and stellar attention to details.

ESSENTIAL JOB FUNCTIONS:

• Accurately complete the payor enrollment/re-enrollment processes for all clinicians in accordance with payor guidelines, government regulations and Standard Operating Procedures.
• Prepares all enrollment/re-enrollment applications for clinician signature. Review applications for completeness and signature prior to submission to health plan for approval. Track and follow-up on a timely basis to ensure timely submission to health plan.
• Performs extensive follow-up with health plans to expedite participation approval to maximize billing opportunities and reduce risk of claim adjustments. Acts proactively and builds strong relationships with health plans to facilitate the enrollment process.
• Partner with Credentialing, Legal, Finance and other internal departments to obtain required documentation and information for clinicians and billing entities.
• Timely and accurately maintain detailed enrollment status notes, provider numbers and effective dates and files in the provider enrollment databases. Systems include but not limited to IntelliCred, Onbase, Excel Spreadsheets.
•  Identify emerging issues and communicate to provider enrollment team lead and/or manager with recommendations for resolutions.
• Responds to, researches, and resolves problems with provider network participation as it relates to payment denials by working with internal staff, clinicians and health plans.
• Responsible for researching, monitoring and communicating health plan enrollment/re-enrollment policies and procedure changes. Effectively communicates proposed changes and ensures proper system set-up.
• Works independently within scope of responsibility and authority. Understands and follows rigorous state and health plan requirements, determines task priorities and escalates enrollment requiring manager approval or special processing requirements. Must be able to work with high volume enrollments while multi-tasking and driving provider enrollments through completion.
• Accountable for meeting or exceeding departmental payor enrollment performance standards and time sensitive deadlines as defined.
• Adheres to departmental policies and procedures.
• Performs other duties as assigned.

KNOWLEDGE, SKILLS AND ABILITIES:

• Ability to pay close attention to detail and produce extremely accurate work.
• Strong analytical and problem-solving skills.
• Ability to organize and prioritize job tasks and requirements.
• Excellent organization skills with the ability to prioritize assigned duties in an efficient amount of time.
• Ability to effectively perform in a multi-task work environment.
• Strong communication and interpersonal skills.
• Ability to effectively use oral and written communication skills with clinicians, external agencies and management in a courteous and professional manner.
• Must have knowledge of correct English, proper grammar and spelling.
• Knowledge and skills in using personal computers (Windows) with a strong emphasis on Microsoft Office Programs- Outlook, Word, Excel and Adobe Acrobat
• Ability to maintain patience and composure in difficult situations.
• Ability to work well under pressure and meet strict deadlines.
• Ability to maintain confidentiality.
• Ability to exhibit a commitment to teamwork, supporting alignment with company and department goals and objectives, assisting others to develop their knowledge of the company and department, and adapting to changes in a positive manner.

EDUCATION AND EXPERIENCE: 

• Two years office experience or college course work preferred.
• Knowledge of health plan billing and enrollment preferred.

Hourly Rate: $16.33 - $30.21