Provider Enrollment Coordinator (Hybrid - Dallas)

Job Description

Job Description

Integrative Emergency Services, LLC ("IES") is looking for a Provider Enrollment Coordinator  to support the division in facilitating the enrollment process (submitting of applications) for both Individual Providers and Physician Groups / Rosters with the various government and insurance healthcare payors, network managed care contracting plans, and third-party billing entities. This position will support states where we operate that include, but are not limited to : Arizona, Colorado, Texas, Oklahoma, Alabama, Indiana, Missouri, South Carolina, and Florida. This position is also responsible for the accounts receivable on hold pending provider number assignment by the payors.

IES is dedicated to cultivating best practices in emergency care, providing comprehensive acute care services, creating value, and supporting patients, employees, clients, providers, and physicians in pursuit of the highest quality health care.

Role will be a hybrid schedule, typically Tuesday-Thursday in office, at 4835 LBJ FWY, Dallas, TX, 75244

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following.  Others may be assigned.

• Completes CAQH applications for new and existing providers. Will maintain CAQH reporting and attest provider applications every 120 days.
• Following established enrollment procedures and sound practices directly or by working with Enrollment Coordinators.
• Prepares applications for new providers for multiple contracts sites, payors, and states requiring an acute attention to detail, accuracy and knowledge of complex and varied requirements.
• Submit applications electronically to payors based on contracts. Track and follow up on a timely basis to ensure completion of application process and submission to payor for approval.
• Extensive and frequent verbal and written communications with Clinicians, state payors, insurance carriers, third party billing company and internal company staff requiring professionalism and tact to attain or provide all needed information quickly in order to expedite the enrollment of Clinicians in the various plans to maximize billing opportunities.
• Acts proactively and builds strong relationships with payors to facilitate enrollment and obtain provider billing numbers.
• Utilizes templates or prepares correspondence inserting proper provider and group related information for submission of applications to payors.
• Works with in-house and third-party Billing Company for current applications, system updates and identifying / resolving problems. Handles corrections or rejections of claims due to enrollment errors and / or claim submission requirements.
• Conveys issues and status of problems to Enrollment Manager.
• Ensures Held A / R enrollments are submitted on timely basis to avoid risk of claims / adjustments and an unnecessary increase of Held AR. Maintain and work reports of held A / R to maximize income opportunities.
• Accountable for meeting or exceeding divisional and / or corporate Enrollment performance standards and meeting time-sensitive deadlines as defined.
• Update status of application in system databases and in excel reports for accurate reporting.
• Works independently within the scope of responsibility and authority. Understands and follows state and payor requirements, some of which are quite complex, and determines which applications require management approval or special processing requirements.
• Able to work with high volume enrollments while multi-tasking and driving provider enrollments through completion.
• Assist and maintain enrollment reporting for different payors including Superior Health, Healthscope, and Cigna.
• Will work and assist with the Enrollment Master Reports and track application submissions, re-validations and re-enrollment for all providers and groups.
• Will support operations in the (9) states that IES operates in

Arizona, Colorado, Texas, Oklahoma, Indiana, Missouri, Alabama, South Carolina, and Florida

QUALIFICATIONS

Knowledge, Skills, Abilities :   To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education / Experience :   Include minimum education, technical training, and / or experience preferred to perform the job.

Required :

Preferred :

PHYSICAL DEMANDS :   The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORK ENVIRONMENT :   The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position.

The company is committed to creating a diverse, inclusive, and equitable environment and is proud to be an equal opportunity employer. Qualified applicants of any age, race, religion, nationality, sexual orientation, gender identity or expression, disability, or veteran status will receive equal consideration for positions. We welcome people of diverse backgrounds, experiences, and abilities and believe that the unique experiences of our team drive our success.

Powered by JazzHR

KXqUwOSE6X