Job Description

Description:

In this role, the worker will interact with the Minute Clinic Team to coordinate Provider Clinic enrollment support. Experience with Medicaid enrollment and provider provisioning In this role, the worker will interact with MinuteClinic Team to coordinate credentialing providers, provider enrollment. Experience with Medicaid enrollment, provider provisioning, must have and use MD Staff, CAQH. The Payer Enrollment Coordinator will be responsible for ensuring corporate compliance with statutory requirements for Medicare, Medicaid, and Commercial enrollment for Clinics and Providers. This Individual will have the ability to work well with others; collaboratively with internal and external vendors and create partnerships through effective relationship building skills. This role will interact and work directly with new and existing Government /Commercial payers across the country. Analysis will include developing of provider and clinic level reporting insuring we are meeting all criteria for enrollment within our compliance policy for Government /Commercial. Payer Enrollment Coordinator will interface and work directly with the Providers, and also with Payer Relations and Revenue Cycle Operations Teams (Credentialing, Accounts Receivable, Billing, and Call Center) Clinical Ops Teams, and MinuteClinic Field and Operations Management, in order to ensure integration of all processes.

1. Maintain existing contracts: a) Complete, maintain, and monitor applications for Initial enrollment and Revalidation with Government Payers and some Commercial for Clinics and Providers in order to ensure active participation in Medicare and Medicaid programs. b) Maintain working knowledge of statutory regulations for Medicare, Medicaid, and Commercial enrollment and claims submission requirements. c) Ensure timely and accurate Group/Provider enrollment applications are submitted for Medicare and Medicaid programs. d) Minimize deactivation of government applications by following quality control procedures. e) Contact Providers when Revalidation notices are received in order to obtain signature pages and validate current general information. f) Receive escalated claim issues from other internal departments and coordinate contact with payer to develop solutions and when brought to resolution; communicate to others internally as appropriate.
2. System updates, project work load, reporting, and communications: a) Update Credentialing and Billing systems with Provider information upon inquiry or receipt from payers. b) Create content for state summary, policy and procedures, maintain existing training modules. c) Research potential issues, develop solutions and bring to resolution. d) Send communication/updates to the field as needed.
3. Financial Analysis: a) Research and analyze trends ( i.e. claims, providers, clinics) in order to make recommendations for process improvements and system efficiencies b) Keep an issue log with all provider payer issues for your states each week. c) Work with SPM and CPM’s to ensure that all providers are enrolled in the correct locations, report on all discrepancies and plan for process improvements. d) Review all Claims on manager hold/hold – i.e. trends, errors, enrollment in new locations, correct ins. Pkg. review non-billable services, etc.
4. Establish/create and maintain payer enrollment tracking system: a) Ensure all enrollments and specific data is maintained timely and accurately in the tracking system so all information can be easily referenced. b) Identify and improve tracking system for efficiency.
5. Mailbox/Billing Dept Issues: Maintain and respond in a timely manner to all inquires. Escalate billing issues if needed in order to obtain prompt resolution.

Experience

At least 1 years of overall related experience of Center for Medicare/Medicaid Services (CMS) guidelines for Medicare Part D enrollment processes or previous work experience in regulatory environment Dependable/Responsible/Accountable Excellent spoken and written communication skills Capable of managing through transition, while fostering a positive team environment Confident in decision making ability within strict timelines Exceptional prioritization and organizational skills Acts with integrity and uses sound judgment in dealing with confidential information

Education

Verifiable High School diploma or GED required; Bachelors Degree in Marketing preferred

Company Description

Medical Recruitment Strategies (MRS) is a recruiting firm that specializes in the placement of professionals in pharmacies, hospitals, healthcare organizations and life sciences companies. We offer contract and direct hire services and work all over the U.S. Over the last 16 years, we have become a premier provider of talent.