Enrollment Analyst Details

Enrollment Analyst

Prisma Health - Columbia, SC

Employment Type : Full-Time

Inspire health. Serve with compassion. Be the difference.

Job Summary

Responsible for Prisma Health Governmental / Managed Care enrollment processes required for successful claims adjudication for all services rendered by Prisma Health Partners In Health /providers and facilities. Supports management in daily operations. Maintains provider/facility data-base used for enrollments, EHR registration and source of truth population/regular updates into Epic.

Accountabilities

• Serves as representative for Prisma Health's CEO, CFO, COO and Executive Director of Revenue Cycle with the Centers for Medicare and Medicaid (CMS) and Prisma Health contracted payors. Responsible for initiating legal governmental documents for maintaining enrollment and re-validation for all facilities/providers to ensure successful claims adjudication. 30 %
• Manages the implementation of all new facility acquisitions by the Prisma Health in conjunction with Prisma Health Medical Group(s) location acquisitions to include Change of Ownerships, Disclosure of Ownerships, and Epic implementations for total claim reimbursements. Mediates and or disseminates rules and regulatory updates directly to directors and managers that affect billing protocols. Work with billing companies to maintain current applications, system updates, and updated regulations. 20 %
• Serves as a Delegated Official and Provider/Facility Surrogate in the Governmental Identity and Access System (I & A). Processes all new provider enrollment and re-validation for all billing providers/facilities. Update and maintain provider/facility information ensuring that it is consistent in all CMS governmental databases (Identity and Access (I&A), PECOS (Medicare), EHR and NPPES (NPI) Systems so that claims will not deny . 15 %
• Follow up on all information such as W-9s, EFTs, and banking information until completion and payment of claim. 5 %
• Analyze governmental/payor regulations and requirements to properly complete all appropriate payer applications for each provider contracted with Prisma Health (per provider per location). Responsible for obtaining and validating personal information from providers, handling this information in a confidential, secure manner, and completing the enrollment/re-validation in order to bill for services rendered though any Prisma Health practice location and/or facility. Continue this process supporting all changes in a providers billing over the course of their employment (ie legal name changes, credential changes, additional satellite locations, etc 5 %
• Responsible for providing information for Epic and electronic data interchange (EDI) for submission of claims to all payors, including EFTs, billing/remit information, updated banking information and current contact information. Complete "Disclosure of Ownership and Control Interest Statement" for Prisma Health to obtain CLIAs for all clinical areas. 5 %
• Research qualifications and regulations to determine eligibility and oversee annual and ongoing registration for special programs that increase reimbursement for Prisma Health such as Meaningful Use EHR (Electronic Health Records), PCMH (Patient Centered Medical Homes), Affordable Care Act Increased Medicaid, and CIN (Clinical Integration Network). 5 %
• Provide support for all billing areas of Prisma Health. Analyze claims rejections and continually work until resolution for both facilities and providers (Provider Edits) with all Prisma Health payors. Participate in monthly payor calls (30+ payers) to handle claims resolutions that result from incorrect loading of providers by payors or major payor data system failures. Mediates and distributes payor rules and regulatory updates directly to directors and managers that affect billing protocols. Work with Billing Companies to maintain current applications, system updates, and updated regulations. 5 %
• Coordinate and maintain data needed for enrollment, contracting, and other related purposes. Data includes but is not limited to the SSN, Medical degree, education, Drug Enforcement Administration (DEA) number, state license number, Board certifications, CV malpractice insurance, and state insurance forms. 5 %
• Annual enrollment for all incoming Prisma Health Residents in the Medicare program. Procurement includes NPI, education, personal and professional information for purpose of ordering and referring while at Prisma Health. Complete 855-O Medicare application for all residents so that they can be ordering providers. Manages the request for outside physicians referring/ordering provider files . Monitor Epic work ques and ensure providers are enrolled properly before moving out providers to Claims testing work ques. Verify referring and attending/ordering providers and move along to Epic Security to allow referrals and orders to be entered in Epic. Properly upload applications and approvals on all providers within Echo database. Review all provider data prior to submitting applications to Medicare and Medicaid and all other contracted payors. Attend implementation calls for new practice locations ensuring properly enrolling new locations with Medicare, Medicaid, and our contracted payors. Validate accuracy of our dba listing and other provider data when other departments request information. 5 %

Supervisory/Management Responsibilities

This is a non-management job that report to a supervisor, manager, director or executive.

Minimum Requirements

Education - Associates's degree Business, Healthcare Administration or similar degree

Experience - 1 year Healthcare billing, claims processing and/or managed care experience

Required Certifications/Registrations/Licenses

n/a

In Lieu Of The Minimum Requirements Listed Above

High School and 3 years of healthcare billing, claims processing and/or managed care experience.

Other Required Skills and Experience

• Knowledge of office equipment
• Proficient computer skills (word processing, spreadsheets, database)
• Data entry
• Mathematical skills

Work Shift

Day (United States of America)

Location

1200 Colonial Life Blvd

Facility

7001 Corporate

Department

70019224 Provider Enrollment

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.