What are the responsibilities and job description for the Provider Enrollment Specialist II position at Easterseals MORC Logo?
Facilitate enrollment of new Easterseals MORC 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 Easterseals MORC 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
Resolve outstanding AR accounts at a defined level of productivity
Maintain confidentiality of all provider enrollment business/work and medical staff information
Identifies issues requiring additional investigation and evaluation; validate discrepancies and ensure appropriate follow up.
Retains detailed and accurate lists of insurance plans in which providers participate and their effective dates with each plan.
Responds to inquiries from payer organizations regarding credentialing and privileging issues as they arise.
Performs follow up with insurance plans to resolve provider enrollment issues and obtain provider participation status.
Communicates with providers and staff members regarding each provider’s participation status in insurance plans.
Sends updated list of providers and their effective status with insurance plans regularly to staff as needed
Notifies insurance plan representatives of a provider’s change in status or when a provider leaves agency.
Re-credentials providers as required by individual insurance plans.
Scans provider documents and store electronically in provider database.
Performs other duties as assigned.
Salary.com Estimation for Provider Enrollment Specialist II in Auburn, MI
$44,152 to $53,437
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