ROLE:  

The Senior Provider Enrollment Coordinator is responsible for working with all appropriate parties to resolve provider enrollment related matters.  This position coordinates department activities and ensures all organizational credentialing activities are processed accurately, in a timely manner and in accordance with CMS and Third Party Payor standards and established guidelines. 

 

TASKS AND RESPONSIBILITIES:

Schedules and organizes work assignments. Prioritizes and delegates job tasks to ensure timely completion.  Ensures work is performed accurately and efficiently. Ensure department response to verbal and written internal or external customer inquiries within policy and procedure timeline. Assists in the review, development and maintenance of departmental policies and procedures, and advises on the development of overall guidelines and best practices. Implements policies and procedures to maintain workflow standards. Maintains manuals of policies and procedures, contract guidelines, and other relevant reimbursement material. Oversees daily department activities per policies and procedures. Audits department functions for compliance to policy and procedure, contract and government regulations. Effective improvement of operational processes to achieve maximum efficiency, accuracy and data integrity. Researches and analyzes complex issues.  Resolves claims issues related to practitioner or group enrollment and identifies and communicates opportunities for process improvements. Collaborates with the legal, compliance, tax and other departments to obtain and or ensure maintenance of certifications, licenses or other documents necessary for compliance with government payer credentialing and or initial or ongoing enrollment requirements. Address problems as they occur.  Keep manager advised of areas of concern or compliance issues which may lead to deactivation of enrollments or inaccurate completion of responsibilities. Completes all reports according to schedule. Participates in projects as they are requested. Performs other tasks as assigned to support the goals of the organization. Completes enrollment and related applications as needed.  Manages complex enrollment needs. Maintains Electronic Funds Transfer, Electronic Remittance Notice, Electronic Claims Submission and other government related carrier processing applications. Maintains all master files related to government carrier guidelines, pricing, diagnosis and other data needed. Coordinates Special Projects.

 

OTHER RESONSIBILITIES:

Presents to internal or external customers as requested. Provides staff education as requested. Other Duties as assigned.

 

SKILLS|EXPERIENCE:

Bachelor’s degree or five or more years of relevant job experience Minimum of one year medical supervisory experience preferred. Strong oral, written and interpersonal communication skills. Demonstrates initiative, ability to work independently.  Excellent organizational and attention to detail skills required. Must be a team player and self-starter able to exercise sound judgement to handle a variety of issues. Must have a high tolerance for ambiguity and the flexibility to respond quickly and appropriately to changing circumstances and priorities as necessary Able to prioritize, trouble-shoot, and problem solve.  Strong Analytical skills required. Must have ability to manage multiple and competing priorities. Demonstrates a sound understanding of customer service principles and practices. Computer skills required.  Advanced use of Excel.

 

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.

 

While performing the duties of this job, the employee is frequently required to stand; to handle or feel; to talk and to hear.  The employee is occasionally required to walk, sit, reach with hands and arms and stoop, kneel, crouch or crawl.  The employee must occasionally lift and or move up to 15 pounds.  Specific vision abilities required by this job include close vision, depth perception and ability to adjust focus.

 

WORK ENVIRONMENT:

Standard office or home office environment.

Pay Rate: $48,000-55,000

 

Benefits: 

                TridentCare offers a competitive wage and robust benefit package to full time employees.  Part time employees are eligible for many of the same below, pro-rated.  Benefits include:

Two weeks of vacation time Health Insurance after 30 days! Sick time 8 paid holidays Same day pay available Medical insurance allowance, giving you the freedom to customize your plan to fit your needs Dental insurance Vision insurance Disability insurance Company paid life insurance 401(k)