HBP Provider Enrollment Specialist

Job Description

Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.

Summary:
The Provider Enrollment Specialist is responsible for enrolling providers with Government and Commercial payors timely and error-free. The PE Specialist will also be responsible for completing payor revalidations timely. This position requires solid verbal and written communication skills, attention to detail, and work effectively in a team environment.

Essential Duties and Responsibilities:

• Accurately prepare and complete the payor applications for Government and Commercial payors for the Emergency Medicine and Hospitalist providers, in accordance with government regulations, payor guidelines, and Standard Operating Procedures.
• Follow up on enrollment submissions to secure provider approval.
• Maintain CAQH and payor revalidations for existing providers, ensuring there is no revenue delay.
• Create and maintain detailed enrollment submissions, follow-up activities, files, effective dates, and provider numbers in the Provider Enrollment Software, MD Staff.
• Responsible for due-diligence and monitoring any changes with payors related to enrollment requirements, while keeping the Standard Operating Procedures current and escalating payor or provider issues to Management.
• Collaborate and partner with internal CHS Departments, Credentialing, Managed Care, Accounts Receivable, ensuring the integrity of the revenue is preserved.
• Assist with any special projects and/or duties as assigned.

Qualifications:

• Required Education: High School Diploma or GED
  Preferred Education: Some college
• Required Experience:
  • Minimum of 3 years of Enrollment experience.
  • Knowledge of NPPES and CAQH.
  • Knowledge of Governmental and Commercial Payor Enrollment processes.
  • Knowledge of CMS Regulations and guidelines.
• Required License/Registration/Certification: None
• Required Computer Skills: Proficient in using Microsoft Excel, Microsoft Word, Adobe, and Google applications.

Physical Demands:
In order to successfully perform this job, with or without a reasonable accommodation, the following are outlined below:

• The Employee is required to read, review, prepare and analyze written data and figures, using a PC or similar, and should possess visual acuity.
• The Employee may be required to occasionally climb, push, stand, walk, reach, grasp, kneel, stoop, and/or perform repetitive motions.
• The Employee is not substantially exposed to adverse environmental conditions and; therefore, job functions are typically performed under conditions such as those found within general office or administrative work.