Provider Enrollment Specialist Virtual(Job Number: 25537-154200)
Work Location: United States-Tennessee-Brentwood-Nashville Physician Service Center
Job Type: Admitting Registration Clerical & Scheduling
Parallon believes that organizations that continuously learn and improve will thrive. That's why, after more than a decade, Parallon remains dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future.
As one of the healthcare industry's leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized services in the areas of revenue cycle, purchasing, supply chain, technology, workforce management and consulting.
Parallon's purpose is simple. We serve and enable those who care for and improve human life in their communities.
Provider Enrollment Specialist
Job Summary – The Provider Enrollment Specialist is responsible for processing enrollments for new and existing individual providers and group practices, such as initiating new enrollments with Commercial and Governmental payors and reporting demographic or other provider changes. Other duties include follow-up on open applications with providers or payors, including escalation to the Provider Enrollment Account Management team or Strategic Pricing and Analytics (SPA) Managed Care Team for resolution.
Supervisor – Provider Enrollment Manager
Supervises – None
Duties (included but not limited to)
Ensure provider participation with contracted payors by taking appropriate next actions to complete enrollment, such as completing applications, rosters, and notifications
Escalate items to other areas outside of department as needed
Work with payors and providers to ensure compliance with enrollment process
Initiate contact with payors and practices via telephone or electronic methods with respect to provider enrollment and billing errors, utilizing proper customer service protocol
Update and maintain data in appropriate Provider Enrollment systems while ensuring accuracy and data integrity
Review correspondence received and perform appropriate action to resolve
Appropriately resolve or escalate payor application denials
Meet and maintain established departmental performance metrics for production and quality
Maintain working knowledge of workflow, systems, and tools used in the department
Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
Other duties as assigned
Knowledge, Skills, and Abilities
Communication - communicates clearly and concisely, verbally and in writing, utilizing proper punctuation and correct spelling
Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
Interpersonal skills - able to work effectively with other employees, patients, and external parties
PC skills - demonstrates proficiency in Microsoft Office applications and others as required
Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures, and systems
Basic skills - demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes; able to work quickly and accurately in a fast-paced environment while managing multiple demands; able to work both independently and collaboratively as a team player; demonstrates adaptability, analytical and problem solving skills, and attention to detail; and able to perform basic mathematical calculations, balance and reconcile figures, and transcribe accurately
High school diploma or GED required
Minimum one year related healthcare experience preferred, such as Medicare/Medicaid Enrollment or Managed Care Enrollment. Relevant education may substitute experience requirement. Knowledge of National Plan and Provider Enumeration System (NPPES) and Council for Affordable Quality Healthcare (CAQH) preferred. Provider Enrollment experience preferred.
Physical Demands / Working Conditions– Requires prolonged sitting/standing, some bending, stooping, walking and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports or other information. Requires lifting papers/boxes and pushing/pulling up to 25 pounds occasionally. Work is performed in an office environment or hospital setting. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations.
OSHA Category– The normal work routine involves no exposure to blood, body fluids, or tissues (although situations can be imagined or hypothesized under which anyone, anywhere, might encounter potential exposure to body fluids). Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency care or first aid, or to be potentially exposed in some other way.