Payer/Provider Enrollment Specialist
Stride Community Health Center
- Wheat Ridge, CO
- Permanent
- Full-time
- Responsible for ensuring timely and accurate medical group and individual enrollments with government, commercial, and pharmacy payers for FQHC and professional fee claim reimbursement. Follows-up with managed care organizations and government payers to ensure timely and accurate enrollment.
- Participates in enrollment progress update meetings with front-end operations and compliance teams. Provides status information to stakeholders. Keeps detailed notes about enrollment progress in provider enrollment database and distributes information to organizational stakeholders.
- Submits provider change and termination requests to all health plans in a timely manner. Informs commercial and government payers and internal SCL stakeholders of provider and clinic updates.
- Collaborates and coordinates with Recruitment in the onboarding and off-boarding of providers.
- Completes all payer re-credentialing requests and demographic/roster requests. Completes payer roster comparisons with internal SCL roster twice a year.
- Builds strong, communicative, collaborative relationships with payer representatives.
- Participates in team work sessions to address Epic hold and denial work queues and communicate issues and trends to leadership. Collaborates with AR to identify claim denial trends and with Coding to identify trend denials related to CPT codes and specific payer types.
- Maintain a working knowledge of Medicare 855 and CO Medicaid enrollment requirements and regulations. Ensure that appropriate education and communication is conveyed to organizational stakeholders.
- Maintains industry best practices for government, commercial, and pharmacy payer enrollments and ensures compliance to government rules and regulations.
- Reports out Provider Enrollment Epic work queue metrics to management. Conducts root-cause analysis to identify and resolve provider enrollment claim issues to minimize denials and reduce key metrics such as AR and write offs related to provider not on plan. Monitors and proactively identifies, researches, and proposes solutions to address market trends.
- Executes and coordinates provider enrollment and related duties for clinic growth and expansion
- Obtains and verifies organizational NPI NPPES accounts are up-to-date and accurate with appropriate medical group taxonomy information.
- Coordinate with Stride clinical operations and facilities to update and/or obtain medical group licensure with all payers.
- Documents, educates, and shares knowledge interdepartmentally of provider enrollment changes/issues with all payers. Create and implement streamlined and standard processes and workflows.
- Maintains Provider Enrollment database.
- Execute large enrollment provider/payer projects.
- Other duties as assigned.
- Integrity: Doing the right thing even when no one is watching.
- Compassion: Meeting patients where they are with empathy.
- Accountability: Following through on our commitments.
- Respect: Valuing human dignity.
- Excellence: Embracing a growth mindset and striving for continuous improvement.
- One (1) year previous work experience in a healthcare is preferred.
- Previous work experience in revenue service center is preferred.
- Previous work experience with provider enrollment and/or credentialing is preferred.
- Medical, dental, and vision coverage
- Paid time off (PTO) and holidays
- Health Savings Account (HSA) and Flexible Spending Account (FSA), including dependent care options
- 401(k) with matching
- Work-life balance
- NHSC Loan Repayment
- Tuition reimbursement and/or Continuing Medical Education (CME)
- No nights, weekends, or major holidays
- Employee Assistance Program (EAP)
- Employee Discounts on top attractions, hotels, more