Provider Enrollment Specialist Resume Sample
Holden Muller
925 Boyle Passage,
Detroit,
MI
+1 (555) 927 5436
Work Experience
Provider Enrollment Specialist
03/2017
-
PRESENT
Dallas, TX
- Prepare and send enrollment applications to Physicians and Advanced
- Work closely with departments credentialing staff and member hospitals to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc.
- St Joseph Hospital- Nashua, NH
- St Mary's- Lewiston, ME
- St Joseph Hospital- Bangor, ME
- Performs the appropriate (applicable) credentialing processes in a timely and complete manner
- Prepare and send enrollment applications to physician and mid-level practitioners for completion
Senior Provider Enrollment Specialist
10/2010
-
12/2016
Houston, TX
- Review completed application and verify all provider information
- Communicate with Credentialing and Legal departments to obtain required documentation
- Maintain record of completed applications via scanning into OnBase system
- Maintain and document all communication with provider and insurance carriers to facilitate application processing/completion
- Record carrier specific provider number and effective date in the Intellicred system
- Research and partner with BSG and Follow Up departments to resolve enrollment issues causing delay or loss of revenue
- Assist manager and/or other team members with provider enrollment assignments based on compliance, project/issues and application volume
- Knowledge of and skill in using personal computers in a Windows environment with an emphasis on basic word processing and data entry into databases
- Communicate with physicians and mid-level practitioners, insurance carriers, outside agencies and management in a courteous and professional manner
Bwpo Provider Enrollment Specialist
09/2004
-
04/2010
Dallas, TX
- This includes legible handwriting and proper grammar
- Maintain patience and composure in difficult situations. Ability to identify, research and solve problems and discrepancies
- 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, adapting to changes in a positive manner that exemplifies commitment and working proactively with minimal supervision
- Identify emerging issues and communicates them to management
- Effectively perform in a multitask work environment
- Maintain database of Provider enrollment information
- Interact with Information Services to insure timely updates of provider information, including but not limited to: UFJP provider number, billing locations, and carrier provider numbers in the EPIC
- Accurately complete the enrollment/re-enrollment processes as outlined by each network/area for all appropriate healthcare providers as identified through department policies and network reimbursement and delegated contracts to ensure timely and continued provider network participation
Education
University of Mount Union
2000 - 2004
School's Degree in Health
Professional Skills
- Excellent written and verbal communication skills, customer service skills, including professional telephone skills
- Communication Skills: Excellent written, verbal and interpersonal communication skills
- Strong written, phone, and verbal communication skills; proven ability to communicate with doctors, hospital administrative and credentialing staffs
- Handle assignments independently and demonstrate analytical skills, human relations, problem solving and interpersonal contacts
- Demonstrate proficiency in data entry and keyboarding skills; Microsoft Word and Excel
- Specific level of software skills as required by unit
- Basic knowledge of the administrative methods and an acumen to develop the required administrative skills of the position
How to write Provider Enrollment Specialist Resume
Provider Enrollment Specialist role is responsible for basic, administrative, software, database, microsoft, adobe, reporting, training, integration, auditing.
To write great resume for provider enrollment specialist job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Provider Enrollment Specialist Resume
The section contact information is important in your provider enrollment specialist resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Provider Enrollment Specialist Resume
The section work experience is an essential part of your provider enrollment specialist resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous provider enrollment specialist responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular provider enrollment specialist position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Provider Enrollment Specialist resume experience can include:
- Maintain detailed provider enrollment files in electronic format, including electronically received documents and scanning of hard copy documents, and document each stage of enrollment/re-enrollment process thoroughly
- Timely and accurately maintain all internal systems with appropriate provider and network participation information. Systems including, but not limited to Qlikview, Epic, Echo, PET, IGUIDE and NPL Tracker
- Develop and maintain good working relationships with Nemours providers and support staff to obtain necessary and timely information to facilitate the provider enrollment/re-enrollment process
- Assists Supervisors and Manager to ensure team is utilizing resources efficiently and effectively
- Interpersonal Skills - Maintains confidentiality of all patient information and company documents
- Billing or reimbursement experience desired
Education on a Provider Enrollment Specialist Resume
Make sure to make education a priority on your provider enrollment specialist resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your provider enrollment specialist experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Provider Enrollment Specialist Resume
When listing skills on your provider enrollment specialist resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical provider enrollment specialist skills:
- Uses oral and written communication skills to effectively convey ideas in a clear, positive manner that is consistent with Mission
- Communicate effectively with high level Associates within the hospital and in the community where tact, diplomacy and good judgment are essential
- Excellent customer service, follow-up, and communication skills
- Problem solve, make decisions and effectively communicate issues and progress
- Effectively and efficiently perform in a multitask work environment
- Able to speak and communicate clearly and effectively
List of Typical Experience For a Provider Enrollment Specialist Resume
1
Experience For Senior Provider Enrollment Specialist Resume
- Order ID cards, handle return mail and other clerical skills
- Updates & maintains database to show enrollment tracking, effective dates, provider numbers and correct provider demographics
- Makes recommendations to management to improve efficiency effectiveness of current manual processes through systemic modifications
- Compiling data, verifying data
- Processing various CMS Provider Enrollment Applications
- Responsible for completing analytical functions, special projects and be cross trained on running varies reports from multiple systems
2
Experience For CSS Provider Enrollment Specialist Resume
- Resolves edit issues from Billing Operations department pertaining to enrollment
- Processes more complex transactions and in auditing work
- Processes more complex transactions, such as expenses, banking or other activity
- Screens, tracks, reports, processes and completes incoming provider file updates
- Assists call center agents, all internal departments, providers, and potential providers with resolving Provider Enrollment issues and inquiries
- Makes and receives phone calls from providers and practice managers to help resolve payer issues and verify participating status
- Scans and files all paperwork and documents to a shared folder for tracking purposes and proof of submission to payers
- Completes online applications for Doing Business As (DBA) for new or renamed groups
- Support over 4000 providers (MDs, DOs and mid-level providers) through the enrollment and recredentialing processes
3
Experience For Bwpo Provider Enrollment Specialist Resume
- Serves as information resource to health care providers and all of Eskenazi Health regarding enrollment status and processes with various payers
- Provides/edits necessary information to maintain/update current doctor master files in the various billing systems within Eskenazi Health
- Develop and maintain relationships with Network Representatives in order to facilitate the provider enrollment/re-enrollment processes
- Responds to, researches, and resolves problems with provider network participation as it relates to denial of services or reimbursement by working closely with all levels of administrative and clinical personnel and network representatives
- Performs follow up with health plans in order to expedite participation approval by each health plan
4
Experience For Provider Enrollment Specialist Resume
- Responsible for educating providers, administrators and support staff regarding the enrollment/re-enrollment processes and how it relates to the provider’s ability to provide care to network members in order to increases reimbursement and reduce patient dissatisfaction
- Work collaboratively with fellow team members to create, evaluate and maintain department workflows, processes, policies and systems. In addition to training support staff (as needed)
- Adheres to Nemours Policies and Standards of Behavior
- Complies with HIPAA Privacy Regulations
- Complies with OSHA/Safety Regulations
- Working knowledge of office products and credentialing/ enrollment software required. Critical thinking and data analysis skills. Ability to create correspondence clearly taking into consideration the audience knowledge
- Highly developed intra-personal and team-building skills; excellent verbal and written communication skills; ability to problem solve and resolve conflicts; demonstrated organizational and time management skills
- Analytical - Collects and researches data; Uses intuition and experience to compliment data. Possesses a solid attention to detail to ensure accuracy of information
5
Experience For Senior Provider Enrollment Specialist Resume
- Customer Service - Responds promptly to customer needs in a professional manner
- Written Communication – Writes clearly and informatively; Edits work for spelling and grammar; Presents numerical data effectively; Able to read and interpret written information
- Adaptability - Adapts to changes in the work environment
- Respect sensitive and confidential data
- Provide clear and efficient written and verbal communication with customers and peers
6
Experience For CSS Provider Enrollment Specialist Resume
- Apply computer knowledge to proper use of internal systems including, but not limited to, Epic, Echo, Excel, Remedy PE Tracker, PaperPort/OmniPage (scanning), Internet, email and word processing
- Assemble, organize and present factual provider information derived from a variety of original and secondary sources
- Is able to work well with others and independently; customer service oriented
- Conducts primary source of verification for prospective and current providers
- Occasional travel to other facilities
- Ensures enrollment is submitted to third party payers within defined time frame
- Coordinates Medicare and Medicaid enrollment/re-enrollment and managed care credentialing and contracting processes for providers. Serves as customer service liaison
- Performs all functions in a courteous and professional manner
- Review applications for completeness and accuracy
7
Experience For Bwpo Provider Enrollment Specialist Resume
- Verify all new enrollment information is accurately entered into our system
- Requests NPI numbers for providers and clinics as necessary and maintains NPI files
- Reviews Athena correspondence and unpostables
- Verifies information on forms, vouchers or other accounting documents according to process guidelines. Contacts internal and external departments to obtain required information, documents, or payments
- Handles questions and inquiries. Resolves issues as assigned
- Enters the provider data once the data are validated for accuracy so that providers are paid correctly from the beginning of their affiliation with the Plan. - Acquires and demonstrates a thorough knowledge of the unique arrangements and ensures the Plan enrolls providers with those arrangements
- Independently initiates oversight of existing provider record problems. Identifies system problems with provider set up and facilitates resolution so that provider payments are accurate
- Communicates with Business Development, Business Integration and Credentialing to acquire prospective new provider group’s required documents and/or signatures as needed
- Maintain provider’s profile in PE Tracking system (IC) with up to date with information on active or pending providers by completing all data fields in the Demographics, Appointments and Applications screen for the provider and group practice
8
Experience For Provider Enrollment Specialist Resume
- Maintain provider’s profile in CAQH with up to date with information on active or pending providers by completing all data fields pertaining to demographics, service locations, group entity information, required documents and expirables
- Validates status of on boarding provider’s enrollments to ensure Target Start Date is met. Escalates to PE management when necessary in order to meet desired Target Start Date
- Working knowledge of COBRA laws
- Determine pre-existing condition time periods
- To accurately add, delete and update eligibility records
- Understand Client Benefit Plan Documents and be able to incorporate the rules for each group
- Be a liaison between Claims and Customer Service departments in order to have claims processed accurately
- Work with various vendors and vendor systems to maintain eligibility
9
Experience For Senior Provider Enrollment Specialist Resume
- Maintain HRA and FSA accounts
- Maintain reference materials with current information
- Manages the completion and submission of provider enrollment applications for all insurance types for multistate hospital system through the Council for Affordable Quality Healthcare (CAQH) database, including enrollment and reassignment of Medicare and Medicaid programs
- Serves as point of contact for hospitals with regards to questions on Medicare/Medicaid provider enrollments. Addresses inquiries in a timely manner and includes appropriate personnel in other departments as appropriate to ensure that the hospitals obtain complete and accurate information to their enrollment questions and concerns
- Implements and maintains tracking tools to record status of all practitioner applications processed for signature by corporate executives
10
Experience For CSS Provider Enrollment Specialist Resume
- Exercises independent judgment to escalate issues as appropriate
- Researches practitioner enrollment processes for multiple state enrollment to ensure applications are filled out accurately. Provides feedback and request revisions as necessary prior to obtaining signatures by corporate executives
- Coordinates and performs follow-up with insurance payers via phone, email, fax or website to resolve provider enrollment issues and ensure timely revalidations
- Processes and maintains timely CAQH enrollments and re-attestations
- Coordinates communication to various Headquarters departments (revenue cycle, network management, legal) and Shriners Hospitals for Children leadership of provider start dates, welcome letters and appropriate provider ID numbers as appropriate
List of Typical Skills For a Provider Enrollment Specialist Resume
1
Skills For Senior Provider Enrollment Specialist Resume
- Advanced computer skills using word, excel, adobe and web-based applications
- Basic knowledge of the administrative methods, and an acumen to develop the required administrative skills of the position
- Basic knowledge of the administrative methods, and an acumen to develop the required administrative skills of the job
- Experience in a physician medical practice and basic understanding of various payer billing requirements and claims processing
- Basic skill level in Adobe Standard (for example: openings a document, editing text, inserting text boxes)
- Experience reviewing and auditing own work or others' work
- Experience using Microsoft Office products and OneApp or similar credentialing database
- Knowledge of and skill in using personal computers in a Windows
2
Skills For CSS Provider Enrollment Specialist Resume
- Able to adapt to frequently changing work priorities
- Experience with healthcare provider enrollment and/or credentialing
- Provider enrollment or credentialing experience required
- Two years experience working with professional customers (i.e., physicians)
- Answer questions about the Vermont Medicaid enrollment and revalidation process from new and existing healthcare providers
- Skill and proficiency with Microsoft Office and databases
- Organize priorities and projects
- Minimal experience in enrollment
3
Skills For Bwpo Provider Enrollment Specialist Resume
- Relevant work experience in multi entity healthcare administration
- Generate ‘Applications Sent to Carrier but not Effective’ reports from Teamworks
- Working knowledge of medical insurance carrier policies and procedures, and State and Federal rules and regulations
- Solve complex problems to support the planning, organizing, and coordinating of provider payer credentialing
- Participates in Billing System Training exercises and updates
- Has a comprehensive understanding of credentialing, network enrollment and managed care processes and terminology
- Provides administrative and technical support to the provider credentialing and re-credentialing process
- Assists in training on the Billing System software package when necessary
4
Skills For Provider Enrollment Specialist Resume
- Work autonomously (organized self-starter requiring little supervision to focus on and accomplish required tasks)
- Maintains strict confidentiality with regard to provider information and understand/adheres to sound physicians HIPAA Privacy & Security policies and procedures
- Generates various reports to identify outstanding claims issues with provider numbers and non-payment
- Participates in company sponsored enrollment/credentialing meetings and other educational activities
- Light lifting of files and manuals
- Apply computer knowledge to proper use of internal systems including, but not limited to, Epic, Echo,
- Understand and work in a complex, multi-hospital owned, multi-practice setting
- Consistent demonstration of accuracy, thoroughness and timeliness in completing assignments
5
Skills For Senior Provider Enrollment Specialist Resume
- Provide customer service to clinic contacts, providers, billing offices, and payers
- Maintain record of completed applications via scanning into system
- Research and communicate with government carriers regarding state specific
- Performs delegated credentialing process for all carriers with whom there is an agreement
- Performs various clerical functions related to the credentialing process
- Perform and review all provider credentialing checks
- Complete all weekly and monthly reporting, as required
- Serves as a Superuser of the Billing System to be available to answer questions from the various clinics
- Processes accounting transactions that require a more comprehensive knowledge of the process flows in the department
6
Skills For CSS Provider Enrollment Specialist Resume
- Helps run basic and more complex reports following standard processes. Prepares reports as required by procedures
- Well-organized, detail oriented, able to meet deadlines with minimal errors
- Provides timely delivery of high quality credentialing information and conducts a formally defined quality control and performance improvement process for the Central Business Office with periodical reporting to users
- Under the direction of the Coordinator, initiates and completes initial and revalidation applications for payor enrollment; ensures accuracy and completeness of all documentation. Serves as a primary liaison with other offices, individuals, and external institutions and agencies on day-to-day credentialing issues
- Responds timely to internal and external inquiries regarding status of enrollment applications and file maintenance requests
- Researches and/or contacts providers to resolve enrollment application and/or file maintenance deficiencies
- Establishes, maintains, and updates files, databases, records, and/or other documents. Reviews and screens initial and reappointment medical staff credentialing applications for completeness, accuracy, and compliance with Centralized Credentialing Policies and Procedures
- Responsible for purchasing supplies, maintaining subscriptions, check requests, faxing, scanning and expense reports for the division
- Responsible for accurate input and modifications to the Credentialing database
7
Skills For Bwpo Provider Enrollment Specialist Resume
- Exhibit a commitment to teamwork, supporting alignment with
- Attends monthly User’s Group meetings
- Prepares materials and files necessary to comply with external audits by payors and/or governmental agencies. Disseminate new/modified professional information to HMOs and to B&T departments
- Identify, research and solve problems
- Work overtime and put forth extra effort when needed
- Collects and maintains data on providers for Medicare and Medicaid enrollment
- Prepares and submits applications to Medicare and Medicaid for new provider enrollments and existing provider updates; follows up by telephone or in writing, with carriers regarding application status
- Complies with Medicare and Medicaid provider enrollment guidelines
8
Skills For Provider Enrollment Specialist Resume
- Reach and stretch intermittently
- Assemble, organize and present factual provider information derived from a variety of original and
- Analyze complex reports and spreadsheets
- Work proactively with little supervision
- Experience in a physician medical practice with a basic understanding of various payer billing requirements and claims processing or experience with payer credentialing/enrollment requirements
- Work in a very close team
- Accountable for your own work
9
Skills For Senior Provider Enrollment Specialist Resume
- Work in a pay for performance environment
- Demonstrated competence using Microsoft Office products especially Word, Excel, Outlook, Access, PowerPoint. Experience or knowledge of ONYX, FACETS and/or similar provider data and/or claims processing system
- Detail oriented with exceptional communication and organizational skills
- Prior experience in the health care or managed care industry is desirable
- Three (3) years’ experience with provider and/or provider reimbursement systems area
- Experience with all Microsoft office tools (Excel, Word, Access)
- Handle multiple priorities and manage stress appropriately
10
Skills For CSS Provider Enrollment Specialist Resume
- Manage multiple deadlines and prioritize multiple assignments
- Work as part of a cohesive team
- Self-starter who excels in a fast-paced, task oriented environment
- General understanding of the medical staff organization and Joint Commission/Healthcare Facilities Accreditation Program/National Committee for Quality Assurance standards and State/federal/licensure regulations particularly as it relates to the provider enrollment
- Expertise with Adobe Pro and Microsoft Office (Excel, Word, PowerPoint, Outlook, etc.) required
- Proficient in Word, Excel and PDF Converter
- Good interpersonal skills and the ability to successfully communicate with people from all levels within the organization as well as with external parties, including government contacts
- Familiarity with government regulations and legal research
- Knowledge of the Medicaid and Medicare programs
List of Typical Responsibilities For a Provider Enrollment Specialist Resume
1
Responsibilities For Senior Provider Enrollment Specialist Resume
- Works closely with the external provider enrollment departments (insurance based) to discern specific application/enrollment requirements including pre-requisites, forms required, form completion requirements, timelines, supporting documentation, and regulations
- Maintains ongoing current assignment spreadsheets and reporting related to completed provider enrollments, provider enrollments in process and revalidation timelines/processes
- Maintains appropriate provider enrollment information in the provider regulatory credentialing repository (MD Staff), optimizing efficiency, and performs queries, reporting and document generation as needed
- Works closely with hospital and executive leadership, and appropriate hospital staff to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc
- Establishes and maintains close working relationships with hospital credentialing coordinators, network management, providers and other hospital/headquarter departments as appropriate and payer contacts
- Interact effectively with a variety of people (physicians, insurance reps and medical staff offices)
- Coordinate and maintain a tracking database for provider contracts and re-validation, re-credentialing and enrollment applications and correspondence
2
Responsibilities For CSS Provider Enrollment Specialist Resume
- Salesforce experience is desirable
- Works closely with Physicians to obtain missing documentation for providers pertaining to provider enrollment
- Support ResCare’s Business Development Team in connection with corporate transactions, including mergers and acquisitions
- Work AR department and/or operations to resolve billing issues
- Participate in daily management huddles and ongoing process improvement events to support a culture of continuous evaluation of quality and improvement
- Coordinates the application and enrollment process for new and existing physicians and providers. Ensures applications are completed timely and precisely
3
Responsibilities For Bwpo Provider Enrollment Specialist Resume
- Interact externally with various federal and state agencies, government payers and managed care organizations
- Adherence to Company and governmental guidelines with respect to confidential and protected health information
- Interact professionally with providers and ancillary staff to provide appropriate and timely response to inquiries and concerns regarding provider enrollment and file maintenance for Medicaid programs including dental, vision, ambulance, physicians, nurses and all other provider types
- Compose and send deficiency letters to notify providers of incomplete inaccurate applications revising existing deficiencies and sending corrected letters based on QA audits as required
- Respond to inquiries regarding status of applications received
4
Responsibilities For Provider Enrollment Specialist Resume
- Research and contact providers to resolve enrollment application deficiencies
- Send out provider applications, forms and other provider correspondence as requested
- Maintain strict confidentiality of information and job files as dictated by current HIPAA requirements
- Respond to Tier III escalations and or file maintenance requests as assigned within the specified due dates
- Flexibility to work overtime as dictated by daily production inventory requirements
- Completes provider payer enrollment/credentialing and recredentialing with all identified payers in a timely manner. Handles highly sensitive and confidential information regarding professional providers. (50%)
- Obtains updated provider information from various sources including provider offices, state licensing boards, malpractice insurance companies, residency training programs, etc. Identifies and resolves problems with primary source verification elements by interpreting, analyzing, and researching data. (10%)
5
Responsibilities For Senior Provider Enrollment Specialist Resume
- Proactively obtains updated provider credentialing data prior to expiration. Creates, develops, and maintains applicable matrices and/or utilizes departmental software that supports the enrollment functions. Completes all additions, updates, and deletions. Supports new provider onboarding processes as related to enrollment. (5%)
- Provides updates to on-site practice management staff and others with any changes to requirements for credentialing individual providers based on government and commercial payer credentialing processes. Proactively communicated any changes regarding contracting as it relates to enrollment and operations. (5%)
- Communicates updated payer enrollment information including payer provider numbers to practice operations in a timely manner while fostering working relationships and team work with departments, vendors, etc. (5%)
- Develops databases and spreadsheets for tracking organization providers. Ensures data is accessible/transparent for executive inquiries or other information as deemed necessary by management. (5%)
- Continuously searches for process improvements to achieve accuracy and efficiencies. (5%)
- Monitors provider enrollment process to assure accuracy and timeliness
- Coordinates and expedites the flow of completed enrollment forms to the carrier using a series of activities designed for collection and submission of supporting documentation
6
Responsibilities For CSS Provider Enrollment Specialist Resume
- Collaborates with the University of Miami Medical Group (UMMG), clinical departments and administrative offices, and Managed Care Organizations on the provider enrollment process
- Collaborates with Center for Medicare and Medicaid Services (CMS), Region 4-Florida Carrier-Blue Cross Blue Shield of Florida (BCBSFL), Agency of Health Care Administration/Division of Health Quality Assurance (AHCA)
- Screens, tracks, reports, processes and completes incoming Medicaid provider enrollments
- Provides outreach to the provider when necessary documentation is missing and returns incomplete enrollment applications as appropriate
- Follows the Enrollment Desk Level Procedures
- Prepares provider enrollment applications and/or written link letters to be sent to payers
- Ensures all providers and groups are re-validated with payers on a timely basis by completing re-credentialing applications with current provider information and signatures
7
Responsibilities For Bwpo Provider Enrollment Specialist Resume
- Ensures SLUHN billing department has resolution on enrollment issues that assist with claim processing
- Applies for New Jersey licensure for identified providers
- Creates and submits new group enrollment applications for newly opened or moving practices. Fields and responds timely to inquiries from SLUHN departments to help resolve enrollment related issues
- Identifies and communicates current or potential enrollment issues that could result in loss of revenue and/or patient dissatisfaction
- Participates in team meetings and conference calls with payers
- Creates check requests for out-of-state enrollment fees
- Work with the Provider Enrollment team in all phases of provider enrollment, ensuring the timely and accurate enrollment of providers in the various payers (Medicare, Medicaid and commercial health insurance companies)
- Collaborate with billing company representatives, providers, various insurance carriers, and internal MedAmerica team members to resolve payer questions and issues
- HRIS or Benefits experience also considered
8
Responsibilities For Provider Enrollment Specialist Resume
- Responds to telephone inquiries and complaints using standard scripts and resources
- Provides highest level of customer service for both internal and external customers
- Create and maintain database information and manage the data process and documentation flow to facilitate a smooth enrollment process. Prepare/populate enrollment forms for providers; ensure timely receipt of required health plan enrollment forms from on-boarding providers, verify information before submitting
- Document and distribute health plan provider numbers as received from government payors and delegated payors. Track enrollment with payors and follow up on outstanding confirmations, working with payors toward resolution
- Establish and maintain relationships with the health plans, serving as a link between third party payors and Fairview
- Establish and maintain a strong relationship with a myriad of internal departments such as, Central Billing Office working together to eliminate write-offs, Physician Recruitment and System Credentialing Departments tracking provider’s progress through their credentialing/enrollment
- Support the Behavioral Health, Institute for Athletic Medicine and other service lines by enrolling and tracking provider’s progress through their credentialing/enrollment and recredentialing processes. Other services such as Chiropractors, Registered Dieticians, and Genetic Counselors
9
Responsibilities For Senior Provider Enrollment Specialist Resume
- Demonstrated proficiency with computer databases
- Enroll, track and document enrollment of CRNAs. Work with outside agencies on outstanding claim issues and bring to resolution
- Enroll Fairview facilities and practitioners with outstate Medicaid programs. Track facility enrollment, and once completed, enroll providers as needed. Support outside agency with Out of State Medicaid enrollment tasks
- Enroll all provider types with Medicare Railroad program as needed
- Work closely with the University of Minnesota Physicians Provider Enrollment team with the enrollment of UMP Employed-Fairview billed providers. Track their progress through credentialing/enrollment
- Additional projects as requested by Clinic Managers, and the Fairview Central Billing Office. Resource of all health system demographic information
- Establish and maintain National Provider Identification (NPI) numbers for clinics, ancillary and facility services throughout the health system. Establish and maintain an active enrollment status of each location with commercial and government payors
- Maintain NPI Fairview Health Services Master NPI Listing. Track all changes within the master listing on behalf of the entire health system
10
Responsibilities For CSS Provider Enrollment Specialist Resume
- Complete mandatory registration, revalidation and reporting of all facilities (including Home Medical Equipment, Orthotics & Prosthetics) with CMS (Medicare) and Medicaid
- Complete payor enrollments and all related forms in order to achieve successful enrollment outcomes in a timely and defect-free manner with healthcare payors
- Consistently document work assignment progress, enrollment follow-up status, and relevant in-process tasks within the specified systems and time frames
- Communicate with healthcare payor enrollment contacts to understand process and use this information to forecast accurate estimated effective dates for providers
- Complete related administrative tasks that support the enrollment process included but not limited to: document imaging & indexing and preparation of check requests
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