What are the responsibilities and job description for the Enrollment Representative position at Tanana Chiefs Conference?
Location
Fairbanks, AK, US
Organization Name
Health Services
Job Summary
Job Summary: Job incumbent is responsible for coordinating, monitoring, and maintaining the provider enrollment and re-enrollment process in a timely and compliant manner with government and commercial payers. Facilitates all aspects of provider enrollment, including initial enrollment, re-enrollment, monitoring, and appointment for the medical staff and allied health practitioners. 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 Revenue Cycle Operations, to resolve any billing issues related to provider enrollment and promote optimal reimbursement.
Adhere to the TCC Ch’eghwtsen’ model of service and guiding principle which requires providing timely and effective service along with the ability to interact with others in a way that inspires trust and demonstrates respect, compassion and empathy.
Essential Functions
Essential Functions: This list is ILLUSTRATIVE ONLY and is not a comprehensive listing of all functions and tasks performed by incumbents. Incumbent(s) may not be required to perform all duties listed and may be required to perform additional, position-specific duties. Under the direct supervision of the Revenue Cycle Director, job incumbent:
Representative Duties: Under the direct supervision of the Revenue Cycle Director:
1. Timely communication and direction to Revenue Cycle Director.
2. Facilitate enrollment of new providers to ensure proper and timely billing and collections.
3. Prepare enrollment applications for selected health plans including Medicare and Medicaid.
4. Complete data entry and processing of enrollment applications, with validation of provider submitted information to ensure the application is complete, accurate, and meeting standards.
5. Obtain licensure, certification and insurance certificates at time of enrollment and maintain in database in order to submit with enrollment applications.
6. Maintain timelines on enrollment processes, and address and/or escalate any delays.
7. Provide monthly notification of new providers, resignations, and changes in provider status such as practice locations and panel status to contracted plans.
8. Follow-up with necessary contracts, including providers and facility contracts, to resolve enrollment application issues and deficiencies.
9. Respond to internal and external inquiries on routine enrollment and contract matters, as appropriate.
10. Maintain strict confidentiality of all provider enrollment business/work and medical staff information.
11. Prefer familiarity with IHS statistical reporting, tribal billing guidelines and special requirements.
12. Is familiar with and assures enforcement of Privacy Act requirements in all business office activities.
Other Responsibilities:
1. Obtain relevant training as needed to maintain applicable skills and knowledge.
2. Assures enforcement of Privacy Act requirements in all Business Office activities.
3. Supports the Billing Team when necessary.
4. Perform other job related duties as assigned.
Minimum Qualifications
Minimum Qualifications:
1. High school diploma or GED equivalent, required.
2. Accounting or Business degree, which may be substituted for by two (2) years of experience in healthcare billing at the discretion of the hiring manager.
3. Must obtain Provider Enrollment Specialist Certificate within fifteen (15) months of hire date.
4. Must pass criminal background pursuant to federal Indian Child Protection and Family Violence Prevention Act requirements and State of Alaska background check.
Knowledge, Skills and Abilities:
1. Knowledge of insurance claim processing and third part reimbursement.
2. Knowledge of state and federal regulations as they pertain to billing processes and procedures.
3. Skill in effective and oral, written and interpersonal communication.
4. Skill in time management and project management.
5. Ability to work efficiently under pressure.
6. Ability to work independently and take initiative.
7. Ability to deal with constant changes and deal effectively with challenging situations.
Supervision: This position does not have any supervisory responsibility.
Supervision
Physical demands: Work is primarily sedentary with some walking, bending and lifting. Will require some evening and weekend work. Incumbent is required to work effectively in a busy, sometimes stressful environment.
Summation
Summary: Incumbent must be able to maintain strict confidentiality. Incumbent works under minimal supervision. Supervisory skills with ability to deal with different situations are required of this position.
Salary : $39,708 - $54,607