What are the responsibilities and job description for the Provider Enrollment Specialist (Full-Time, M-F) position at Washington Regional Medical Center At North Hills?
Overview
Position Type
Job Shift Days
Education Level 4 Year Degree
Category Administrative/Clerical
Description
Organization Overview, Mission, Vision, and Values
Our mission is to improve the health of people in the communities we serve through compassionate, high-quality care, prevention, and wellness education. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country. Our 425-bed medical center has been named the #1 hospital in Arkansas for four consecutive years by U.S. News & World Report. We employ 3,400 team members and serve the region with over 45 clinic locations, the area's only Level II trauma center, and five Centers of Excellence - the Washington Regional J.B. Hunt Transport Services Neuroscience Institute ; Washington Regional Walker Heart Institute ; Washington Regional Women and Infants Center ; Washington Regional Total Joint Center ; and Washington Regional Pat Walker Center for Seniors .
Health Partners is a membership-driven physician-hospital organization (PHO) that exists to deliver contract management and other advocacy services for healthcare professionals.
Position Summary
The Provider Enrollment Specialist reports directly to the Health Partners Provider Enrollment Manager. This position serves in a crucial role in coordinating, monitoring, and maintaining the provider enrollment and re-enrollment process in a timely and compliant manner with all government and commercial payors. This position facilitates all aspects of provider enrollment, including initial enrollment, re-enrollment, tracking, and monitoring. This position assists with problem identification and timely resolution of payor related issues surrounding claim submission and denial management to ensure optimal reimbursement.
Essential Position Responsibilities
- Enroll each new provider into the selected health plans by submitting the required documentation to the designated payor contacts.
- Submit provider changes and terminations to all selected health plans to the designated payor contacts.
- Track provider loading completion for each payor and follow up on loading discrepancies or inaccuracies.
- Maintain accurate rosters for all health insurance payors and submit payor rosters at designated intervals or upon request of a specific payor.
- Track health insurance plan participation for all providers.
- Serve as point-of-contact for enrollment status inquiries.
- Notify provider designated representative of loading completion and the respective dates for each payor.
- Resolve any claims disputes resulting from provider enrollment and loading issues.
- Provide general administrative support to the PHO office and work closely with PHO staff.
- Assist with other duties, as assigned, including but not limited to credentialing and database management functions.
Qualifications
- Education: Bachelor's degree in healthcare administration or a minimum of 2 years of applicable experience in provider relations or healthcare administration.
- Licensure and Certifications: N/A
- Experience: Previous experience in provider relations or healthcare administration preferred (required in lieu of degree). Competent in Microsoft Office and must have skill in organizational, interpersonal, and verbal/written communication skills.
Work Environment : This position will spend 80% of time sitting while performing work in a standard office environment. This position will spend 20% of time standing and/or walking while pushing, pulling, lifting, and/or carrying up to 50 lbs.
Qualifications