Duty/Responsibility % of Time
1. Maintain existing contracts:75%
- Complete, maintain, and monitor applications for Initial enrollment and Revalidation with Government Payers and some Commercial for Clinics and Providers in
order to ensure active participation in Medicare and Medicaid programs.
- Maintain working knowledge of statutory regulations for Medicare, Medicaid, and Commercial enrollment and claims submission requirements.
- Ensure timely and accurate Group/Provider enrollment applications are submitted for Medicare and Medicaid programs.
- Minimize deactivation of government applications by following quality control procedures.
- Contact Providers when Revalidation notices are received in order to obtain signature pages and validate current general information.
- Receive escalated claim issues from other internal departments and coordinate contact with payer to develop solutions and when brought to resolution;
communicate to others internally as appropriate.
2. System updates, project work load, reporting, and communications: 10%
- Update Credentialing and Billing systems with Provider information upon inquiry or receipt from payers.
- Create content for state summary, policy and procedures, maintain existing training modules.
- Research potential issues, develop solutions and bring to resolution.
- Send communication/updates to the field as needed.
3. Financial Analysis:9%
- Research and analyze trends ( i.e. claims, providers, clinics) in order to make recommendations for process improvements and system efficiencies
- Keep an issue log with all provider payer issues for your states each week.
- Work with SPM and CPM's to ensure that all providers are enrolled in the correct locations, report on all discrepancies and plan for process improvements.
- Review all Claims on manager hold/hold - i.e. trends, errors, enrollment in new locations, correct ins. Pkg. review non-billable services, etc.
4. Establish/create and maintain payer enrollment tracking system:5%
- Ensure all enrollments and specific data is maintained timely and accurately in the tracking system so all information can be easily referenced.
Identify and improve tracking system for efficiency.
5. Mailbox/Billing Dept Issues: 1%
- Maintain and respond in a timely manner to all inquires.
- Escalate billing issues if needed in order to obtain prompt resolution.
PRIOR WORK EXPERIENCE:
- 3 - 5 years
REQUIRED SKILLS:
1. Demonstrated understanding of insurance and billing procedures regarding Medicare, Medicaid, and Commercial in multi-state, multi-entity environment.
2. Provider/Clinic Enrollment with government audit/compliance experience.
3. Excellent written and verbal skills including formal and effective presentation and ability to impact and influence peers, leaders and key stakeholders.
4. Project planning and the ability to participate on multiple cross-functional project teams to achieve on-time results.
5. Ability to understand data, analyze reporting and make sound recommendations and business decisions.
6. Strong credibility and relationship management skills with internal and external customers.
7. Work all claim holds, (i.e trends, denials, provider, clinic, non-billable services, determine if there is payer/provider issue, log all claims daily in excel/access, weekly summary reporting and resolution).
LEADERSHIP COMPETENCIES REQUIRED:
- Focuses on Customer and Market
- Makes Sound Business Decisions
- Partners across Boundaries
- Contributes to High Performing Teams (Individual Contributor) OR
- Manages and Develops Self (Individual Contributor) OR
SCOPE:
The Payer Enrollment Coordinator reports directly to the Manager interacting regularly with Providers, Revenue Cycle Operations Teams (Accounts Receivable, Billing, Call Center, and Credentialing), Clinical Ops Teams, and MinuteClinic Field and Operations Management to ensure integration of all processes.
IMPACT:
This Payer Enrollment Coordinator role carries significant responsibility that affects customer service, cash flow, field engagement, compliance and legal. Inaccuracy in this role will negatively impact field operations, legal, regulatory, customer service, and financials.
POSITION SUMMARY: This position is responsible, under the supervision of the Manager of the Payer Enrollment Dept. to:
* Ensuring timely and accurate processing of Payer Enrollment applications (Initial and Revalidations) for Clinics and Providers.
* Provide quality control for timely and accurate individual enrollment applications submitted for Medicare and Medicaid programs.
* Resolve claims issues for individual payers in corporate billing system.
* Researching, completing and maintaining compliance with individual Government payers through credentialing, re-credentialing and audit processes and procedures.
* Contact Providers when Revalidation notices are received in order to obtain signature pages and validate current general information. Interact with the field (SPM and CPM's) in regards to escalation notices.
* The Payer Enrollment Coordinator will be responsible for identifying and quantifying trends/issues and then effectively communicating them to the appropriate members of the management team along with what the potential impact could be.
* Minimize denials and deactivation of government applications where applicable to reduce key metrics including DSO, cost to collect, percent of aged claims, and Bad Debt.
* Update Credentialing and Billing systems with Provider information upon inquiry or receipt from Government /Commercial payers.
The Payer Enrollment Coordinator will be responsible for ensuring corporate compliance with statutory requirements for Medicare, Medicaid, and Commercial enrollment for Clinics and Providers. This Individual will have the ability to work well with others; collaboratively with internal and external vendors and create partnerships through effective relationship building skills. This role will interact and work directly with new and existing Government /Commercial payers across the country. Analysis will include developing of provider and clinic level reporting insuring we are meeting all criteria for enrollment within our compliance policy for Government /Commercial. Payer Enrollment Coordinator will interface and work directly with the Providers, and also with Payer Relations and Revenue Cycle Operations Teams (Credentialing, Accounts Receivable, Billing, and Call Center) Clinical Ops Teams, and MinuteClinic Field and Operations Management, in order to ensure integration of all processes.
8 am 4:30 pm Mon-Fri |
