Position Goal

Maintain an up-to-date knowledge of payor policies and procedures and oversee the timely and accurate enrollment of new providers, new locations for existing providers, and Hughston facilities with appropriate payors by the Payer Enrollment Team. Collaborate with internal stakeholders, such as the billing and credentialing departments, to ensure a seamless transition from application to reimbursement.

Position Responsibilities:

• Lead the Payor Enrollment Team through the enrollment process including application completion, submission and follow up with payors to prevent and resolve any enrollment issues
• Conduct thorough research on current payor requirements and communicate changes to the relevant stakeholders.
• Coordinate with the Billing Department to ensure successful reimbursement of claims submitted to payors
• Ensure accurate and up-to date provider data is maintained in digital platforms (i.e. Athena/Verity)
• Establish and maintain strong relationships with payor representatives to facilitate smooth communication and problem resolution.
• Monitor and report on enrollment metrics
• Provide support and education to Payor Enrollment Team regarding processes and requirements.
• Facilitate processes to allow for increased efficiency of the payor enrollment process.
• Ensure maintenance of all CAQH/PECOS/NPPES profiles for all providers.
• Complete and coordinate paperwork for ERA, EDI, EFT, and other electronic channels between the organization and payers in the electronic billing system, and with enrollment services.
• Ensure that payor revalidations are completed timely to prevent any lapse in enrollment.
• Ensure practice addresses are current with government and commercial health plans, agencies and other entities by continuously updating rosters and payer directories.
• Terminate enrollment with government and commercial payers upon resignation or termination of providers.
• Use the electronic billing system, along with any of the organization’s proprietary spreadsheets or software, purchased or leased, as the primary source of immediate notification and maintenance of enrollment related data.
• Monitor the maintenance of the electronic billing system enrollment services dashboard tasks and worklists requirements.
• Monitor for trends in enrollment process completion to establish timely resolution and eliminate delays.
• Manage Payor Enrollment Team. Provides necessary direction, feedback, completes job performance reviews and approves/monitors time.
• Maintain confidentiality of provider information.
• Assist in other credentialing, licensing, privileging items as needed.

Experience:

Required:

Three years of direct payor enrollment experience and 1 year management experience.

Education:

Required:

• Associate degree or higher in related field

Preferred:

Provider Enrollment Specialist Certification (PESC).

Special Qualifications:

Required:

• Strong knowledge of reimbursement processes and payor guideline
• Ability to work independently with minimal supervision.
• Requires skill in computer systems and applications.
• Must have outstanding organizational and oral/written communication skills.
• Must be able to prioritize work to meet deadlines despite frequent interruptions.
• Exceptional attention to detail and high level of accuracy.
• Ability to work in a team environment.
• Must be able to prioritize tasks and use good professional judgment in assigned duties.

Must be able to prioritize tasks and use good professional judgment in assigned dutiesThe Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.