Top 3 Utilization review specialist Jobs in Greenville, Sc

Provider Enrollment Specialist
New Horizon Family Health Services —Greenville, SC
- Mid-level
- Databases
- Business Administration
- Health savings account
- Paid holidays
The Onyx Group - Denial & AR Follow-Up Specialist
Tribe513 | The Onyx Group —Greenville, SC
- Full-time
- Writing skills
- HIPAA
- Research
Quick Apply
Manager, Accounts Receivable
Ovation Healthcare —Welcome, SC
- Full-time
- Acute care
- Writing skills
- High school diploma or GED

Discover related jobs

Based on your search for utilization review specialist jobs.

Documentation Specialist
AdaptHealth, LLC —Asheville, NC
Clinical roles require valid licensure/certification, where applicable. Request and track prior authorizations, including coordination with state Medicaid…
Quick Apply
Utilization Documentation Specialist, Resource Pool
Self Regional Healthcare —Greenwood, SC
Preferred: BSN or Baccalaureate degree in health-related field; Two years experience as Utilization Reviewer/Care. CPR within 1 month of employment.
Quick Apply

Show more related jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
Clinical Reviewer - Medical Coder & QA
Ohio Living —Westerville, OH
Current unencumbered license for the state of Ohio to practice as a Licenses Practical Nurse (LPN) preferred Certificate for OASIS Specialist-Clinical…
Quick Apply

Show more jobs in cities nearby

I want to receive the latest job alert for utilization review specialist in greenville, sc

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

utilization review specialist jobs near greenville, sc

Enrollment Specialist jobs in Greenville, SC

Enrollment Specialist jobs in Houston, TX

Enrollment Specialist jobs in Springfield, MA

Contract Specialist jobs in Maryland

Enrollment Specialist jobs in Overland Park, KS

Learning Specialist jobs in Seattle, WA

Enrollment Specialist jobs in Texas

Accounts Payable jobs in Maryland

Accounts Receivable jobs in Littleton, CO

Accounts Receivable Clerk jobs in Banning, CA

Accounts Receivable Clerk jobs in Prince George's County, MD

Entry Level Accounts Payable jobs in Chicago, IL

Accounts Receivable Clerk jobs in Corona, CA

Accounts Receivable Clerk jobs in San Diego, CA

Court Clerk jobs in Overland Park, KS

Accounts Receivable Clerk jobs in New Haven, CT

Data Entry Clerk jobs in North Carolina

Accounts Receivable Clerk jobs in Rye Brook, NY

Part Time Accounts Payable jobs in Chicago, IL

Accounts Receivable Clerk jobs in Auburn, IN

Provider Enrollment Specialist

New Horizon Family Health Services -
Greenville, SC

Apply Now

Job Details

Benefits

Health savings account
Paid holidays
Disability insurance
Health insurance
Dental insurance
Vision insurance
Employee discount
403(b)
Loan forgiveness
Life insurance

Qualifications

Health insurance policy knowledge
Compliance monitoring
Insurance regulation
Associate's degree

Full Job Description

JOB SUMMARY:

This position is responsible for completing all applications for payer plans for purposes of billing and reimbursement for health care services. This includes incorporation of information gathered from the credentialing process. The Provider Enrollment Specialist is responsible for coordinating, monitoring and maintaining the provider enrollment and re-enrollment process in a timely and compliant manner with all government and commercial plans.

DUTIES PERFORMED:

Greets patients, staff and visitors in a pleasant and professional manner.
Serve as the liaison for troubleshooting any provider or organization enrollment issues.
Keep the Revenue Cycle Director informed at all times of the status of new/revised or pending physician and non-physician provider numbers, effective dates, and plan enrollment to prevent delayed claims filing and disruption to cash flow.
Develops databases and spreadsheets for tracking the organization’s provider enrollment.
Accurately maintain all internal systems with appropriate provider and network participation information.
Complete appropriate steps for updating and maintaining Provider Enrollment Databases to ensure claims are processed timely and accurately.
Serve as a member of the Revenue Cycle Management Committee.
Assist other staff in the resolution of provider enrollment issues.
Complete and review applications for all new providers for assigned organizational contracts with various plans.
Maintain CAQH profiles for individual providers when granted access by said provider.
Ensure all work is performed in accordance with established policies and procedures.
Prepare and process provider enrollment applications and organization enrollment applications for Medicare, Medicaid, and other payers.
Track and follow-up to obtain provider numbers.
Build knowledge base for payer requirements and forms.
Obtain required credentialing paperwork from the HR Department.
Maintain organized and accurate files for efficient and effective enrollment tracking to ensure credentialing information is obtained for all physician and non-physician providers to be included in enrollment and re-enrollment applications.
Coordinates delivery of provider applications to appropriate health plans.
Submit applications to payers.
Utilize the available portals of various payers as necessary to complete the enrollment process.
Follow-up and check status of applications with payers until provider and/or organization enrollment is completed.
Attends all in-service training as required.

QUALIFICATIONS:

EDUCATION:
- REQUIRED:
  - Minimum of an Associate degree in Healthcare Administration, Business Administration, or related field

EXPERIENCE:
- REQUIRED:
  - Minimum of two years’ experience in provider enrollment, revenue cycle management or provider credentialing
OTHER REQUIREMENTS:
- Knowledge of insurance regulation and compliance.
- Experience with PECOS and the utilization of the SC Healthy Connections portal.

Benefits and Perks:
New Horizon Family Health Services offers a robust and comprehensive benefit package to full time employees.

Automatic:
- Annual Leave
- Sick leave
- Up to 12 Paid Holidays plus your birthday
- Eligibility for 2 annual bonuses after 1 year of employment when defined eligibility criteria are met
- Continuing education courses through SC AHEC
- Various employee discounts. I.e., Verizon, AT&T, YMCA, etc.
- Eligibility for the Public Service Loan Forgiveness (PSLF) Program
Optional:
- Medical (PEBA State Health Plan), Dental and Vision benefits
- Flexible Spending and Health Savings Accounts
- Voluntary Life Insurance
- Short Term Disability and Long Term Disability
- Accident and Critical Illness Coverage
- 403 (b) Retirement Plan, with up to 4% employer match after the first year of employment

Mission:

Our Mission is to provide quality, affordable, compassionate patient-centered health care to improve the health of the communities we serve. Our Vision is that our community will be one of the healthiest in the Nation. Superior patient care is the hallmark of NHFHS.

ICARE Values:

The ICARE values of New Horizon Family Health Services guide our employees toward achieving the mission of our company and our vision for our community. Our values stand for Integrity, Collaborations, Accountability, Respect, and Enrichment.

Community:

Greenville, South Carolina is the perfect place to live, work, and play. Greenville is surrounded by mountains, lakes, hiking & biking trails, as well as recreational activities including golf, tennis, water sports, cultural performances and more. Geographically located between Atlanta, GA and Charlotte, NC, with beaches just 3.5 to 4 hours away.

We are an Equal Opportunity employer.

Apply Now

Refine Your Search

utilization review specialist jobs in greenville, sc

Provider Enrollment Specialist

The Onyx Group - Denial & AR Follow-Up Specialist

Manager, Accounts Receivable

Discover related jobs

Explore jobs in cities nearby

I want to receive the latest job alert for utilization review specialist in greenville, sc

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected