Government Enrollment Specialist Managed Care

Texas Health Huguley FWS; Town of Florida (NY); Remote; USD 40,000 - 60,000; Full time

Job summary

A healthcare organization is seeking a Government Enrollment Specialist to manage the Medicare and Medicaid enrollment programs. The role involves coordinating applications, ensuring compliance, and working closely with healthcare providers. Candidates must have high attention to detail, strong organizational skills, and knowledge of healthcare billing procedures. This position is remote, offering flexibility while supporting a vital service within the healthcare community.

Benefits

Benefits from Day One

Whole Person Wellbeing Resources

Mental Health Resources and Support

Qualifications

• High attention to detail and accuracy; strong organization skills are essential.
• Working knowledge of Medicare/Medicaid billing rules and regulations.
• Ability to analyze and manage a demanding workload.
• Strong interpersonal skills to collaborate effectively with team members.

Responsibilities

• Coordinate the enrollment of healthcare providers in Medicare/Medicaid programs.
• Monitor and follow up on application statuses with regulatory agencies.
• Review documentation for completeness and accuracy.
• Assist with audits related to the Medicaid/Medicare application process.

Skills

Attention to detail

Strong organization skills

Effective communication

Analytical skills

Interpersonal skills

Education

High School Graduate or Equivalent

Tools

Electronic medical billing applications

Job description

Job Description - Government Enrollment Specialist Managed Care (25037191)

Job Number: 25037191

Description

All the benefits and perks you need for you and your family:

• Benefits from Day One

• Whole Person Wellbeing Resources

• Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Shift: Monday- Friday Full time 8am-5pm EST

Job Location : Remote

The role you will contribute:

Coordinates the day-to-day administration of Adventist Health System's (AHS) Medicare and Medicaid provider enrollment program, ensuring that all existing and new physicians and other billing health care providers in the AHS system are enrolled in compliance with all affiliation and participation requirements, as well as regulatory and internal policy requirements.

The value you will bring to the team:

• Collaborates with other departments, such as provider onboarding, credentialing, and revenue cycle, to gather necessary information and ensure a smooth application process.
• Offers support and guidance to provider onboarding throughout the application process, answering questions, providing updates on application status, and assisting with any issues.
• Monitors the status of all applications, following up with regulatory agencies as needed to ensure timely processing and approval, and maintaining a tracking system to monitor progress.
• Acts as the primary point of contact with Medicare/Medicaid regulatory agencies, submitting applications, responding to inquiries, and addressing any issues that arise during the approval process.
• Identifies any issues or delays in the application process and works to resolve them promptly, troubleshooting problems, coordinating with other departments, or escalating issues to higher management.
• Demonstrated skills in attention to detail and accuracy, while maintaining required productivity.
• Demonstrated strong interpersonal skills and ability to work effectively at all levels in a collaborative team environment.
• Reviews and verifies all documentation submitted by new physicians and advanced practitioner providers to ensure completeness and accuracy, contacting applicants for additional information or clarification if needed.
• Other duties as assigned.
• Ensures that all new physicians and advanced practitioner providers are enrolled in Medicare/Medicaid programs in a timely manner, allowing them to begin billing for services as soon as possible.
• Prepares for and assists with internal and external audits related to the Medicare/Medicaid application process, ensuring that all records are accurate and up-to-date and providing any requested documentation to auditors.
• Continuously evaluates the application process and recommends improvements to increase efficiency and compliance, updating procedures, implementing new technologies, or providing training to staff.
• Oversees the entire Medicare/Medicaid application process for new physicians and advanced practitioner providers, ensuring timely and accurate submission of all required documentation.
• Ensures that all applications comply with federal, state, and organizational regulations and policies, staying updated on any changes in Medicare/Medicaid requirements and implementing necessary adjustments.
• Keeps accurate and organized records of all applications, including tracking the status of each application, maintaining copies of submitted documents, and recording any communications with regulatory agencies.

Qualifications

The expertise and experiences you’ll need to succeed:

· High School Grad or Equiv

· Attentive to detail and accuracy; strong organization skills required.

· Working knowledge and understanding of all rules, regulations, policies, and procedures with regard to health care professional billing under Medicare/Medicaid.

· Ability to communicate effectively, both orally and in writing.

· Analytical, evaluative, and critical thinking skills.

· Knowledge and understanding of electronic data collection and data management systems and procedures.

· Ability to prioritize and manage a demanding workload.

· Working familiarity with Medicare/Medicaid provider billing requirements in all states where AHS has provider medical groups.

· Knowledge of AHS medical practice billing procedures and systems as they relate to Medicare/Medicaid.

· Skill in the use and administration of specialized electronic medical billing applications.

· Strong interpersonal skills and ability to work effectively at all levels in a collaborative team environment.