Out of State Billing - Provider Applications Enrollment Specialist (Remote)

Centauri Health Solutions, Inc; Corpus Christi (TX); Remote; USD 10,000 - 60,000; Full time

Job summary

An established industry player is seeking a Provider Enrollment Specialist to join their dynamic team. This role is essential for processing Out of State Medicaid claims, focusing on hospital billing and enrollment applications. The ideal candidate will have a strong background in medical administration, particularly with Medicare and Medicaid, and possess excellent organizational and communication skills. You will be responsible for managing tasks, preparing complex enrollment applications, and ensuring compliance with payer guidelines. This is a fantastic opportunity to contribute to a vital team in the healthcare sector while honing your skills in a supportive environment.

Qualifications

• Minimum two years of medical administrative experience required.
• Knowledge of Medicare and Medicaid is essential.

Responsibilities

• Manage assigned tasks and meet productivity goals set by management.
• Prepare complex hospital and physician enrollment applications.

Skills

Medicare knowledge

Medicaid knowledge

Decision making

Critical thinking

Communication skills

Microsoft Office

Organizational skills

Education

Medical administrative experience

Tools

PDF viewer/application

Job description

Provider Enrollment Specialist is a vital team member with Centauri’s Out of State Medicaid billing agency that works with facilities across the US to process their Out of State Medicaid claims with a focus on hospital billing, hospital and physician enrollment, and eligibility verifications. All team members are assigned tasks and are responsible for ensuring tasks are completed by the assigned follow up date. The position focuses on completing Out of State Medicaid hospital and physician enrollment applications.

Role Responsibilities:

• Complete Training Plan: Employees must complete a training plan to master role responsibilities. Accounts are audited until the training plan is completed in phases. Utilize internal user procedures and knowledge of Out of State Medicaid payer guidelines.
• Management of Assigned Task Listing: Meet daily productivity goals set by Management. Review all assigned tasks and complete by the set follow up date. Review accounts in a timely manner consistent with identified procedures. Prioritize workload based on follow up date, dollar amount, and/or filing limits. Document findings and status within the system. Identify Payor trends and submit the necessary system updates. Upload supporting documentation to the system. Work together within assigned groups to determine next steps. Utilize multiple systems to prepare enrollment applications and gather the necessary credentials for enrollment.
• Enrollment Applications: Prepare complex hospital and physician enrollment applications using various provider application formats, including paper forms and/or web portal submission. Prepare formal client requests for signatures and credentials according to client specifications. Utilize all resources available to obtain credentials and/or information to prepare enrollment forms and updates. Verify instructions for new enrollments and updates with Out of State Medicaid payers. Responsible for reviewing all client responses to enrollment requests to ensure all requested information was received. Save new credentials/information when received and update client database, including but not limited to hospital license, physician license, CLIA, DEA, liability insurance, board certification, proof of instate and/or Medicare enrollment, etc. Research and understand various provider enrollment application formats, discover new information requested and make decisions to complete the tasks required.

Role Requirements:

• Minimum two years of medical administrative experience; Medicare and/or Medicaid knowledge. Preferred but not required: Previous experience with all aspects of credentialing process; NPPES, PECOS. Knowledge of healthcare provider credentialing and licensure requirements.
• Professional and effective decision making, critical thinking, and communication skills with co-workers, clients, and payers; written and oral.
• 1 year + including Microsoft Office knowledge.
• Drafting letters/formal email requests, preparing documents, and utilizing PDF viewer/application to complete applications according to payer guidelines.
• Detail oriented and outstanding organizational skills with the ability to learn new programs and website interfaces.
• Ability to navigate multiple platforms daily.
• Proven ability to work independently and as a team member.
• Ability to prioritize, organize multiple tasks and remain organized with multiple interruptions.