Enrollment Specialist

The Provider Enrollment Manager will play a pivotal role in managing the integration and ongoing relationship with a new claims clearinghouse vendor. This individual will be at the forefront of ensuring seamless electronic data interchange (EDI) processes, maximizing the efficiency and accuracy of claims data from the billing system to the vendor application system.

Responsibilities

• :Drive the implementation of EDI solutions with the new vendor, including the configuration, testing, and deployment of EDI transactions (e.g., claims, remittance advice, eligibility inquiries, and credit card transactions
• )Guide and participate in payer enrollments or registrations necessary to file claims through the clearinghouse
• .Develop and maintain EDI maps and translation specifications to ensure accurate data transmission between internal systems and the claims clearinghouse
• .Monitor EDI transaction activity, troubleshoot errors or discrepancies, and ensure timely and accurate claims processing
• .Provide training and support to end-users on EDI processes, tools, and best practices
• .Stay current on industry trends, regulatory changes, and best practices related to healthcare EDI standards and revenue cycle management
• .Work closely with IT teams to address technical issues and enhance EDI infrastructure and capabilities
• .Collaborate with the Project Manager to manage EDI-related projects
• .Generate reports and analytics to track key performance indicators (KPIs) related to EDI processing and revenue cycle performance
• .Participate in cross-functional teams and projects aimed at optimizing revenue cycle operations and improving financial outcomes

.Accountabilities and Oversight

• :Develop, coordinate, implement, and manage provider enrollment (PE), EDI, electronic funds transfer (EFT), electronic remittance advice (ERA), and payer web portal requirements with governmental and commercial payers to ensure prompt and accurate payment of submitted claims
• .Demonstrate outstanding attention to detail in obtaining appropriate signatures and verifying application accuracy prior to submission
• .Foster strong communication and interpersonal relationships with payers for both initial enrollment and ongoing management of regulatory changes
• .Develop in-depth knowledge of payer policies, regulations, requirements, and necessary forms across multiple states
• .Navigate various payer systems to understand specific process requirements and utilize online tools for managing the status of enrollments, electronic claims status, remittances, payments, and clearinghouse activities
• .Work closely with internal stakeholders to assess current EDI processes and identify opportunities for improvement
• .Serve as the initial contact for troubleshooting, monitoring document transmissions, and identifying process improvement opportunities regarding government payers
• .Communicate and collaborate with Patient Financial Services, Cash Posting, GE Billing Services, Operational and Compliance leadership to provide technical support and ensure compliant revenue flow
• .Request and organize supporting documentation for provider enrollment applications from multiple departments
• .Develop and maintain a database of all EMS licenses for all base locations to ensure consistency with submitted documentation

.Qualifications

• :Bachelor's degree in healthcare administration, business, information technology, or a related field
• .Minimum of 2 years of experience in PFS management with a focus on EDI processes and transactions. Have a deep understanding of healthcare billing practices, EDI standards, and claims processing workflows
• .A minimum of 2 years of experience of EDI standards (e.g., HIPAA X12, ANSI ASC X12) including experience with transaction sets such as 837, 835, and 270/271
• .A minimum of 2 years working with claims clearinghouse vendors and implementing EDI solutions within a healthcare organization
• .Strong analytical skills and attention to detail with the ability to troubleshoot and resolve EDI-related issues
• .Excellent communication and interpersonal skills, with the ability to effectively collaborate with internal and external stakeholders
• .Proficiency in healthcare billing software, practice management systems, and EDI tools
• .Preferred certifications include SQL Certification, Certified Professional Biller (CPB), o
• rProvider Enrollment Specialist Certificate (PESC)
• .Knowledge of healthcare reimbursement methodologies, payer policies, and regulatory requirements

.BENEFITS INCLUDE

• :Medical, Dental and Vision plan
• sLife/AD&D Insurance Plan
• sDisability Plan
• sFlexible Spending Account
• sEmployee Assistance Program
• sCritical Illnes
• sAcciden
• tLegal Service
• sPet Insuranc
• eHome and Aut