Career Opportunities: Enrollment & Reimbursement Coordinator (114478)

We are seeking an Enrollment & Reimbursement Coordinator who will be responsible for enrolling School of Medicine CPA Faculty, JHCP, JHRP-employed clinical providers, and ancillary support staff with government and managed care payers timely and accurately. Provides on-going education and support to providers regarding Credentialing and Provider Enrollment requirements. Works in close collaboration with the clinical departments, Physicians Billing Service, Core Services/Operations, and the Johns Hopkins Central Credentialing Office.

Specific Duties & Responsibilities

• Enrolls School of Medicine CPA Faculty and ancillary support staff with government and managed care payers timely and accurately.
• Follows Medicare PECOS Provider Enrollment Policy and escalates cases when providers have not responded within specified timeframe.
• Reviews and resolves provider enrollment related rejections daily. Follows Provider Not Enrolled (MCOB7) Resolution Policy to enroll deactivated providers immediately.
• Reviews Provider Enrollment Charge Edits timely to identify and enroll providers who need to be enrolled with Railroad Medicare.
• Reviews Provider Enrollment Related Claim Edits timely to ensure providers with outstanding enrollment s are captured on the “All Dept Provider Enrollment Log” and resolved quickly.
• Thoroughly updates “All Dept Provider Enrollment Log” daily and any tracking logs utilizing standardize formatting.
• Ensures GE Provider Dictionary, NPPES website, and Epic SER records are updated with provider’s most current Medicare and billing related information timely and accurately.
• Ensures Medicare provider enrollment development letters are responded within 30 days from the date on the letter. Escalates cases to the Enrollment Supervisor by the 20th day if unable to resolve the issue.
• Communicates with the Enrollment Supervisor regarding enrollment applications that are returned to identify issues and cases for appeal.
• Audits SER information and updates provider dictionaries effectively.
• Originates ad hoc data reports and summarizes results.
• Audits payer websites for erroneous or missing provider profile data.
• Manages/ updates provider e-mail lists for the Clinical Practice Association.
• Investigates enrollment impacted third party claims rejections and patient referral denials.
• Third party liaison between production units and insurance networks.
• Coordinates all aspects of JHU-CPA individual provider participation with health insurance carriers under their respective delegated credentialing agreements.
• Assures information obtained and transmitted on providers is accurate and timely, to maximize potential revenue through validated participation in payer’s and JHU’s respective IS-systems.
• Monitors and/or maintains process by which providers are recognized and enrolled with payers and satisfactorily set-up in Epic.
• Oversees data integrity in the Epic billing system provider dictionary for key billing provider identities.
• Performs routine monitoring of outliers, as identified by a number of sources including the TES (transaction editing system) in Epic. Handles coordination with departments of any necessary corrective actions.
• Serves as principal liaison to JHM hospital’s respective Medical Staff Offices and the JHM CVO to address status changes, location, etc and the corresponding impact on billing procedures.
• Registration and attestation for CPA Provider’s Meaningful Use Medicaid and Medicare HER.
• Resolve disputes, discrepancies and other provider enrollment related problems, as necessary.

Special Knowledge, Skills & Abilities

• Professional credentialing for commercial and governmental health plans experience required.
• Experience with Third Party payers required.
• Proficient in use of Excel.
• Analytical/problem solving skills required.
• Excellent oral and written communications skills required.
• Ability to interact with all levels of staff.

• Bachelor’s Degree.
• One year of medical office and/or billing experience.
• Additional experience may substitute for required education, to the extent permitted by the JHU equivalency formula.

• Knowledge of the Epic billing system preferred.

Classified Title: Enrollment & Reimbursement Coordinator 
Job Posting Title (Working Title): Enrollment & Reimbursement Coordinator   
Role/Level/Range: ATO 37.5/02/OE  
Starting Salary Range: $18.00 - $33.50 HRLY ($48,000 targeted; Commensurate with experience) 
Employee group: Full Time 
Schedule: M-F 8:30 AM - 5:00PM 
Exempt Status: Non-Exempt 
Location: Remote 
Department name: SOM Admin CPA Contract Services  
Personnel area: School of Medicine