Requisition Posting Title Provider Enrollment Specialist

Ventra Health, Inc.; Mabalacat; Hybrid; PHP 240,000 - 420,000; Full time

Benefits offered by this job

Performance-based incentive plan

Referral bonus

Job summary

Ventra Health, Inc. is seeking a Provider Enrollment Specialist to work with the Provider Enrollment Manager to resolve payer enrollment issues and denials using CMS and external tools.

The role involves contacting CMS, payers, and clients via phone, email, or website to research and enroll payer issues. The position requires an Associate's degree (2 years) with preference for a Bachelor's degree and at least 1 year of enrollment experience.

Qualifications

• Associate's degree (2 years) required; Bachelor's degree preferred.
• At least 1 year of provider enrollment experience preferred.
• Working knowledge of CMS, Medicaid, and third-party payers requirements.

Responsibilities

• Research and resolve payer enrollment issues with CMS and payers.
• Submit CMS Medicare, State Medicaid, and other payer applications.
• Maintain provider enrollment data across systems and documentation.
• Coordinate with clients, operations, and Revenue Cycle Management teams.
• Track payer revalidation dates and ensure active enrollment.

Skills

CMS enrollment

HIPAA privacy & security

Verbal & written communication

Analytical skills

Organizational skills

Problem-solving

Teamwork

Independence

Education

Associate's degree (2 years)

Bachelor's degree in related field

Tools

CMS portals

CMS systems

Job description

About Us

Ventra is a leading business solutions provider for facility-based physicians practicing anesthesia, emergency medicine, hospital medicine, pathology, and radiology. Focused on Revenue Cycle Management, Ventra partners with private practices, hospitals, health systems, and ambulatory surgery centers to deliver transparent and data-driven solutions that solve the most complex revenue and reimbursement issues, enabling clinicians to focus on providing outstanding care to their patients and communities.

Come Join Our Team!

• As part of our robust Rewards & Recognition program, this role is eligible for our Ventra performance-based incentive plan, because we believe great work deserves great rewards

Help Us Grow Our Dream Team — Join Us, Refer a Friend, and Earn a Referral Bonus!

Job Summary

• The Provider Enrollment Specialist works in conjunction with the Provider Enrollment Manager to identify Provider Payer Enrollment issues or denials. This position is responsible for researching, resolving, and enrolling any payer issues, utilizing a variety of proprietary and external tools. This will require contacting clients, operations personnel, and Centers for Medicare & Medicaid Services (CMS) via phone, email, or website

Essential Functions and Tasks

• Performs follow-up with market locations to research and resolve payer enrollment issues
• Performs follow-up with Centers for Medicare & Medicaid Services (CMS), and other payer via phone, email or website to resolve any Payer Enrollment issues
• Manages the completion and submission of CMS Medicare, State Medicaid and any other third-party payer applications
• Performs tracking and follow-up to ensure provider numbers are established and linked to the appropriate client group entity and proper software systems
• Maintains documentation and reporting regarding payer enrollments in process.
• Retains records related to completed CMS applications
• Establishes close working relationships with Clients, Operations, and Revenue Cycle Management team
• Proactively obtains, tracks, and manages all payer revalidation dates for all assigned groups/providers as well as complete, submit, and track the required applications to maintain active enrollment and prevent deactivation
• Maintains provider demographics in all applicable enrollment systems
• Adds providers to all applicable systems and maintains information to ensure claims are held/released based on status of enrollment
• Performs special projects and other duties as assigned

Education and Experience Requirements

• Associate's degree (2 years), required and Bachelor's degree in any related field, preferred.
• At least one (1) year of provider enrollment experience preferred.

Knowledge, Skills, and Abilities

• Working knowledge of specific application requirements for Centers for Medicare & Medicaid Services (CMS), State Medicaid and all third-party payers including pre-requisites, forms required, form completion requirements, supporting documentation such as Drug Enforcement Agency Number (DEA), Curriculum Vitae (CV), and regulations.
• Working knowledge of physician HIPAA Privacy & Security policies and procedures
• Strong oral, written, and interpersonal communication skills
• Strong word processing, spreadsheet, database, and presentation software skills
• Strong detail orientation skills
• Strong analytical skills
• Strong decision-making skills
• Strong problem-solving skills
• Strong organizational skills
• Strong time management skills
• Ability to ensure the complex enrollment packages are complete and correct
• Ability to work cohesively in a team-oriented environment
• Ability to foster good working relationships with others both within and outside the organization
• Ability to work independently and require little supervision, to focus on and accomplish tasks
• Ability to maintain strict confidentiality with regards to protected provider and health information
• Ability to take initiative and effectively troubleshoot while focusing on innovative solutions
• Ability to exercise sound judgment and handle highly sensitive and confidential information appropriately
• Ability to remain flexible and work within a collaborative and fast paced environment
• Ability to communicate with diverse personalities in a tactful, mature, and professional manner

Compensation

• Base Compensation will be based on various factors unique to each candidate including geographic location, skill set, experience, qualifications, and other job-related reasons.

• This position is also eligible for a discretionary incentive bonus in accordance with company policies.

Ventra Health

Equal Employment Opportunity (Applicable only in the US)Ventra Health is an equal opportunity employer committed to fostering a culturally diverse organization. We strive for inclusiveness and a workplace where mutual respect is paramount. We encourage applications from a diverse pool of candidates, and all qualified applicants will receive consideration for employment without regard to race, color, ethnicity, religion, sex, age, national origin, disability, sexual orientation, gender identity and expression, or veteran status. We will provide reasonable accommodations to qualified individuals with disabilities, as needed, to assist them in performing essential job functions.

Recruitment AgenciesVentra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.Solicitation of PaymentVentra Health does not solicit payment from our applicants and candidates for consideration or placement.

Statement of AccessibilityVentra Health is committed to making our digital experiences accessible to all users, regardless of ability or assistive technology preferences. We continually work to enhance the user experience through ongoing improvements and adherence to accessibility standards. Please review at https://ventrahealth.com/statement-of-accessibility/.