Coastal Health & Wellness is seeking a Provider Enrollment Specialist!

The Provider Enrollment Specialist is responsible for coordinating, monitoring, and maintaining the provider enrollment and re-enrollment process in a timely and compliant manner with all government and commercial payors. Facilitates all aspects of provider enrollment, including initial enrollment, re-enrollment, monitoring, and appointment for medical, dental, and behavioral health providers. Assists with problem identification and timely resolution of payor related issues surrounding claim submission and denial management to ensure optimal reimbursement. Position serves as the liaison between managed care plans, payer population health incentive measure and attribution list management, and CHW, including Revenue Cycle Operations to resolve any billing issues related to provider enrollment and promote optimal reimbursement.

We can offer you:

• Excellent benefits; including an amazing retirement package, paid time off plans, FREE life insurance, FREE long-term disability, Affordable medical insurance, FREE parking and much, much more!
• Team Oriented Environment
• Salary Rate: Commensurate with Experience

We want you to join our current team of professionals and continue a long-term career with us! If you meet the criteria listed below, please apply.

Required:

• Bachelor’s degree in health care administration, or related field of study or equivalent industry experience.
• 3 + years in a healthcare or health insurance setting performing registration, back-office support, care management, quality or health analysis required.
• 2 + years of experience and/or training in revenue cycle (health insurance plans and benefits structures) preferred.
• Completion of technical training/certification in a related field (such as Certified Medical Assistant), preferred.
• Knowledge of CPT codes and basic medical terminology (preferred).
• Phone communication skills.
• Bilingual ability (English/Spanish) a plus.
• Must possess or ability to readily obtain a valid driver’s license issued by the State of Texas for the type of vehicle or equipment operated.
• Excellent written and verbal communication skills required.
• Proficient in Microsoft Office (Word, Excel, PowerPoint) required.
• Must be willing and able to work evening and weekend hours if necessary.
• Must follow GCHD Immunizations policy.
• Must follow ICS training requirements.
• Must pass criminal background check and drug/alcohol screening.

An equivalent combination of education and work experience which appropriately demonstrates the knowledge, skills and abilities to perform the above described essential functions will be considered when hiring for this role.

Job Specific Functions:

• Facilitate enrollment of new CHW providers to ensure proper and timely billing and collections.
• Prepare enrollment applications for all health plans including Medicare and Medicaid.
• Complete data entry and processing of enrollment applications, with validation of provider submitted information to ensure the application is complete, accurate, and meeting CHW standards.
• Obtain licensure, certification, and insurance certificates at time of enrollment and maintain in database in order to submit with enrollment applications.
• Maintain timelines on enrollment processes, and address and/or escalate any delays.
• Ensure that all pending enrollments are reviewed, obtained, and managed according to the rules and policies of the department.
• Provide monthly notification of new providers, resignations, and changes in provider status such as practice locations and panel status to contracted plans.
• Follow up with necessary contacts, including providers and managed care organizations, to resolve enrollment application issues and deficiencies.
• Facilitate resolution of provider related denials to ensure appeal procedures are followed to result in proper reimbursement.
• Demonstrate a level of competence and understanding of all state and federal laws, rules, and regulations according to payer guidelines for billing.
• Respond to internal and external inquiries on routine enrollment and contract matters, as appropriate.
• Perform detailed follow-up activities on assigned accounts according to procedures.
• Maintain confidentiality of all provider enrollment business/work and medical staff information.
• Participate in special projects/assignments.
• Read all announcements and relevant communications relating to job duties.
• Successfully complete competency-based training and testing.
• Performs statistical and data analysis, benchmark determination, goal setting, written and graphical reports and data presentations of data for population health management programs (UDS Measures, HEDIS, Medicare STARS, CCO metrics, quality management/improvement).
• Ensures process and formation flow of all population health data. Analyzes impact of data on various quality improvement projects or programs.
• Performs gap analysis of current systems to determine compliance with data reporting requirements.
• Collaborates with other departments as necessary to conduct and complete analyses.
• Attends internal and external meetings to present analyzed data.
• Coordinates work associated with payer incentive agreements.
• Facilitates payer incentive payments and ensures they are received.
• Knowledge of CPT, (Evaluation & Management, E&M) and ICD-10 codes (in addition, SDoH Z-Codes).
• Assists, support and collaborates with the CHW Credentialing Coordinator on all credentialing needs.
• Performs other duties as assigned by supervisor.

No Phone Calls Please

ADA/EEO/DFWP

Our Mission: Protecting and Promoting the Optimal Health and Well-Being of Galveston County