Provider Enrollment Specialist

Job Details

Provider Enrollment Specialist

Department: Payer Contracting & Prov Enrol

Usual Schedule: Mon-Fri 8-5

Regions: Carle Foundation

On Call Requirements: no

Job Category: Professional

Work Location: Carle at The Fields

Employment Type: Full - Time

Nursing Specialty:

Job Post ID: 45418

Secondary Job Category:

Experience Requirements: 1 - 3 Years

Weekend Requirements: no

Education Requirements: Not Indicated

Shift: Day

Location: Champaign, IL

Holiday Requirements: no

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Check out this job opening for Carle Providers: Provider Enrollment Specialist Check out this job opening for Carle Providers: Provider Enrollment Specialist

Job Description

JOB SUMMARY:

The Provider Enrollment Specialist is responsible for ensuring that all forms of enrollment are completed in a timely fashion enabling individual practitioners and facilities to meet all billing and reporting requirements for commercial, state, and government agencies

EDUCATIONAL REQUIREMENTS

Associates Related Field or Five (5) years relevant experience.

EXPERIENCE REQUIREMENTS

One (1) year of general administrative services experience in addition to education requirements. Proficiency in all PC and Microsoft Office Suite Applications, including database management, internet research, and other applications as needed.

OTHER REQUIREMENTS

Extremely detail oriented, with the ability to multi-task and follow through to meet established deadlines. Outstanding written and verbal communication skills with ability to work with all levels of staff and third parties to problem solve and accomplish positive outcomes. Ability to develop and put in place process improvements that increase efficiencies.

ESSENTIAL FUNCTIONS:

• Assemble and complete all Center for Medicare and Medicaid Applications via either PECOS (internet-based Provider Enrollment, Chain and Ownership System) or the paper application for all lines of business (CPG, CFH and HRHC).

• Monitor, document and communicate status of individual applications so claims can be appropriately released for billing.

• Complete or assign to third party consultant all other CMS related applications and change notifications related to system entities and/or locations.

• Monitor and update revalidations for individuals and entities.

• Complete all other enrollment forms for federal and non-federal payors as needed, including roster updates and Electronic Funds Transfer forms with bank account information for incoming claim payments.

• Apply for NPI (National Provider Identifier) for all lines of business and individual providers via online or paper submission process.

• Ongoing education and on-line seminars to keep up with current processes required by CMS and IDPH.

• Submission and attestation for Meaningful Use programs for individual providers and entities. This includes tracking of attestations and incoming funds to confirm completeness of receipts from Medicare and Medicaid.

• Maintain proficiency in Medical Staff Office credentialing software (MSOW) as wells as maintaining provider lists for internal usage and third parties.

• Maintain Provider Enrollment Information and Procedure Manual with regular review and updates, as needed.

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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. We are committed to creating a diverse and welcoming workplace that includes partners with diverse backgrounds and experiences. We believe that enables us to better meet our mission and values while serving customers throughout our communities. People of color, women, LGBTQIA+, veterans and persons with disabilities are encouraged to apply. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal state and local ordinances. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com. Positions are not available for remote work in the state of Colorado.

Effective September 20, 2021, the COVID 19 vaccine is required for all new Carle Health team members. Requests for Medical or Religious exemption will be permitted.

Illinois Required Notices

• Your Rights Under Illinois Employment Laws

Federal Required Notices

• Employee Rights under FLSA

• OSHA

• Employee Rights under FMLA

• EEO It's The Law

• Pay Transparency Nondiscrimination Provision

• Employee Polygraph Protection Act

• Your Rights under USERRA