Job Description

General Purpose of Job:

The Provider Enrollment Specialist works to efficiently complete/maintain provider/practice enrollments, revalidations and any demographic changes with contracted and government payers for the reimbursement of services. Establish and verify all billing information for entry into EPIC to ensure efficient revenue flow. Problem solve enrollment issues with practicies, providers and revenue cycle areas.

• Educate and communicate with providers/practices the enrollment process required for payors to establish the billing process and how it relates to the provider's ability to provide patient care and reimbursement.
• Obtain and communicate NPI(National Provider Information) numbers for new practices.

• Maintain NPI numbers/practice locations in the NPI database.
• Update and maintain all required information for CAQH(Council for Affordable Quality Healthcare) profiles.
• Prepare and submit accurate applications for new practices/providers including EFT(Electronic Funds Transfer) /ERA(Electronic Remittance Advice) enrollments.
• Consistently document work assignment progress, enrollment follow-up status, and relevant in-process tasks within the specified systems and time frames.
• Validate completed enrollment information with supervisors for EPIC claim processing and revenue collection.
• Facilitate revalidation/termination applications needed for all providers/practicies following the payer requirements.
• Maintain all practice location and provider demographic changes with all insurance carriers and CAQH.
• Work with supervisors/billers on denials referencing enrollment issues.
• Maintain detailed provider enrollment files in electronic format, including electronically received documents and scanning of hard copy documents and document each stage of enrollment/re-enrollment process.
• Ongoing training to remain current on enrollment requirements.
• Work collaboratively with fellow team members to create, evaluate and maintain department workflows, processes, policies and systems.
• Provides additional status reports and updates as needed.
• Follows and maintains all confidentiality requirements with provider data.
• Other projects as assigned.

Job Requirements