Key Facts

Remote From:

Iowa (USA) , Minnesota (USA) , North Dakota (USA) , South Dakota (USA)

Full time

English

Hard Skills

Enrollment Management Provider Data Management Billing Site Planning Enrollment Management Organizational Structure Compliance Management

Other Skills

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Communication
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Time Management
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Customer Service
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Detail Oriented
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Problem Solving

Roles & Responsibilities

High school diploma or equivalent (preferred).
Previous experience as Billing Representative, Credentialing, or Provider Enrollment (preferred).
General computer skills and proficiency with Microsoft Office products.
Knowledge of provider enrollment processes, payor requirements, and NPI/NPPES applications (preferred).

Requirements:

Ensure timely enrollment of new providers with payors and new facility sites, and maintain ongoing enrollment including re-enrollment and terminations.
Monitor and maintain provider directories and payor databases for accuracy and regulatory compliance; follow up with payors for effective dates, status updates, and identification numbers for billing purposes.
Update and maintain provider numbers and related data in internal and external billing software and production programs; maintain supporting documentation such as a W-9, CLIA certificate, bank, IRS, and CMS letters as applicable.
Initiate enrollment for electronic claims submission and notify payors and internal contacts of practitioner practice changes, including site changes and terminations.

Sanford Health

About Sanford Health

Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. Headquartered in Sioux Falls, South Dakota, the organization serves more than one million patients and 220,000 health plan members across 250,000 square miles. The integrated health system has 47 medical centers, 2,800 Sanford physicians and advanced practice providers, 170 clinical investigators and research scientists, more than 200 Good Samaritan Society senior care locations and world clinics in 8 countries around the globe. Learn more about Sanford Health's commitment to shaping the future of rural health care across the lifespan at sanfordhealth.org or Sanford Health News.

Company type: Large

Founded: 2018

Company size: 10001

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Job description

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We’re proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Work Shift:

8 Hours - Day Shifts (United States of America)

Scheduled Weekly Hours:

Salary Range: $19.00 - $30.50

Union Position:

Department Details

Summary

Responsible for ensuring the timely enrollment of new providers with payors as well as new facility sites. Responsible for the on-going maintenance of existing providers and facility sites including re-enrollment and maintaining terminations.

Job Description

Monitor and maintain the process of gathering current, accurate, and complete information for provider directories and payor databases in compliance with regulations and payor requirements. Follow up with payors to obtain effective dates, status updates, and identification numbers for billing purposes. Update and maintain provider numbers and related data in both internal and external billing software and production programs. Maintain supporting documentation such as a W-9, CLIA certificate, bank, IRS, and CMS letters as applicable. Apply for or provide assistance with the application process for individual practitioner and/or facility national provider identifier (NPI) via national plan and provider enumeration system (NPPES). Notify payors and internal contacts of practitioner practice changes, including terminations, cases of malpractice, or other legal matters. Also will notify payors of site notification for payors (i.e., for new sites, site terminations, and changes). Perform account follow up on enrollment related denials and take the necessary action for account resolution in accordance with established federal and state regulations. Respond to internal and external inquiries regarding research issues. Review charges and claims pending report and/or claim edit work queues in Epic. May work Epic follow-up work queues to resolve enrollment-related issues. Keep current regarding any changes in managed care and other payor requirements for provider enrollment. Complete work within authorized time to assure compliance with strict departmental and compliance standards as well as payor time limits. Initiate enrollment for electronic claims submission. Attend site-planning meetings to provide input, gather necessary information for set up, and provide updates.

Qualifications

High school diploma or equivalent preferred.

Previous experience as Billing Representative, Credentialing, or Provider Enrollment preferred. General computer skills, including the ability to use the range of Microsoft products General computer skills, including the ability to use the range of Microsoft products required.

Sanford is an EEO/AA Employer M/F/Disability/Vet.

If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org.