Provider Enrollment Specialist - Phoenix, AZ
Employment Type : Full-Time
JOB SUMMARY
- In order to facilitate the prompt and accurate payment of submitted claims the Provider Enrollment Specialist must develop, coordinate, implement and manage provider enrollment (PE), electronic data interchange (EDI), electronic funds transfer (EFT), electronic remittance advice (ERA) and payer web portal requirements with governmental and commercial payers.
- Must demonstrate outstanding attention to detail skills in order to facilitate obtaining the appropriate signatures and verify application accuracy prior to submission.
- Requires strong communication and interpersonal relationship development with payers both for initial enrollment and for managing changes brought about by regulatory requirements.
- Develop in-depth knowledge of payer policies, regulations, requirements and necessary forms for multiple states.
- Must be able to navigate a myriad of payer systems to understand specific process requirements as well as utilize the specific on-line tools for managing the status of enrollments, electronic claims status, remittances, payments and clearinghouse activities.
- Serves as the initial contact for trouble shooting, monitoring document transmissions, and identifying opportunities for process improvements regarding government payers.
- Communicates and works closely with Patient Financial Services, Cash Posting, GE Billing Services, Operational and Compliance leadership and provide technical support to facilitate the prompt flow of revenue in a compliant manner.
- Must be able to independently prioritize and process a high volume of work.
- Must be able to identify and develop workflow processes to meet the ever-changing regulatory requirements
- Request and organize supporting documentation to accompany various provider enrollment applications from multiple departments
- Departments, including but not limited to PHI Health, LLC and/or PHI Group, Inc. Corporate Operations, Corporate Compliance, Legal, Risk Management, Tax, Patient Financial Services, Aviation, Clinical and Financial Services.
- Must have a high level of awareness of PHI Group, Inc., PHI Corporate, LLC and PHI Health, LLC organizational structure in order to provide accurate information to governmental entities assuring the correct corporation/legal entity is represented on applications.
- Develop and maintain database of all EMS licenses for all base locations to assure consistency with submitted documentation.
- Must be able to identify, develop and conduct audits of and for Provider Enrollment and Patient Financial Services.
- Must have excellent communication skills to train on the complexities of payer and regulatory requirements.
- Communicate to management all changes in Medicare/ Medicaid/Tricare/HIS and all other federal payer enrollment requirements.
- Maintain the highest level of confidentiality at all times in accordance with HIPAA guidelines and PHI Group Inc. and PHI Health, LLC policies.
- Adhere to all PHI Group, Inc. and PHI Health, LLC policies and procedures.
- Demonstrate responsiveness and sense of urgency when dealing with payers and internal customers. Possess the ability to initiate and follow through on detailed regulatory requirements.
- Complying with Company HS&E policy and procedures.
- Responsible for supporting company Safety Management Systems activities.
- Understands and provides visible support of Destination Zero.
- Perform other duties as assigned.
SCHEDULE/LOCATION
QUALIFICATIONS/EXPERIENCE
- High school diploma or GED equivalent required.
- Previous provider enrollment experience required.
- Knowledge of general office procedures and using office equipment.
- Demonstrated expertise in MS Office suite software.
- This position is designated Safety Sensitive for purposes of the Arizona Medical Marijuana Act.
SALARY
- Regular pay scale applies
CORE COMPETENCIES:
- Safe -We are absolute in our belief in the tenets of Destination Zero and that Zero is not only achievable, but the only acceptable outcome.
- Efficient - We are focused on outcomes that are smart and responsible by making the best use of our resources to maximize overall productivity and achieve sustainable profitability as a high performing organization.
- Quality -We are committed to ensuring excellent organizational performance which produces sustainable and reliable outcomes.
- Service -We are dedicated to the service of our customers, our communities and each other.
BEHAVIORAL COMPETENCIES:
- Drive & Energy – The ability to maintain a fast pace and continue to produce during exhausting circumstances.
- Functional & Technical Expertise – Allows the individual to add organizational value through unique expertise and serve as a resource to the organization within his/her area of expertise
- High Standards – Sets the stage for continuous improvements, the adoption of best practices and ultimately influences organizational standards.
- Initiative – Takes a proactive approach and takes action without being prompted.
- Integrity – Acts ethically and honestly and applies those standards of behavior to daily work activities.