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

Centauri Health Solutions, Inc; Town of Texas (WI); Remote; USD 40,000 - 65,000; Full time

Job summary

An established industry player in healthcare solutions is seeking a Provider Enrollment Specialist to join their team. This role is crucial in managing Out of State Medicaid claims, focusing on hospital billing and enrollment processes. The ideal candidate will have a strong background in medical administration, particularly with Medicare and Medicaid, and excellent organizational skills. You will work collaboratively to ensure timely completion of tasks while navigating multiple systems. If you are detail-oriented and ready to contribute to a dynamic team, this opportunity is perfect for you.

Qualifications

• Minimum two years of medical administrative experience with Medicare and/or Medicaid knowledge.
• Strong decision-making, critical thinking, and communication skills.

Responsibilities

• Complete training plan to master role responsibilities and meet productivity goals.
• Prepare complex hospital and physician enrollment applications using various formats.

Skills

Medical Administrative Experience

Medicare and Medicaid Knowledge

Decision-Making Skills

Critical Thinking Skills

Communication Skills

Microsoft Office Proficiency

Organizational Skills

Ability to Work Independently

Education

Medical Administration Experience

Tools

Microsoft Office

PDF Applications

Job description

Provider Enrollment Specialist is a vital team member within Centauri’s Out of State Medicaid billing agency, working with facilities across the US to process their Out of State Medicaid claims. The role primarily focuses on hospital billing, hospital and physician enrollment, and eligibility verifications. All team members are assigned specific tasks and are responsible for ensuring their completion by the designated follow-up date.

Role Responsibilities :

1. Complete Training Plan: Employees must complete a training plan to master role responsibilities. Accounts are audited until training is completed in phases. Utilize internal user procedures and knowledge of Out of State Medicaid payer guidelines.
2. Management of assigned tasks: Meet daily productivity goals set by management. Review all assigned tasks and complete them by the follow-up date. Review accounts promptly according to procedures. Prioritize workload based on follow-up date, dollar amount, and filing limits. Document findings and status within the system. Identify payor trends and submit necessary system updates. Upload supporting documentation. Collaborate within groups to determine next steps. Use multiple systems to prepare enrollment applications and gather credentials.
3. Enrollment Applications: Prepare complex hospital and physician enrollment applications using various formats, including paper forms and web portals. Prepare client requests for signatures and credentials per specifications. Use available resources to obtain credentials and information. Verify instructions for new enrollments and updates with payers. Review client responses to ensure completeness. Save new credentials and update client database accordingly. Understand various application formats and make informed decisions to complete tasks.

Role Requirements :

1. Minimum two years of medical administrative experience with Medicare and/or Medicaid knowledge. Preferred: Experience with credentialing processes, NPPES, PECOS, healthcare provider credentialing, and licensure requirements.
2. Strong decision-making, critical thinking, and communication skills, both written and oral.
3. At least 1 year of experience with Microsoft Office.
4. Experience drafting letters, formal requests, preparing documents, and using PDF applications according to payer guidelines.
5. Detail-oriented with excellent organizational skills and ability to learn new programs and systems.
6. Ability to navigate multiple platforms daily.
7. Proven ability to work independently and collaboratively.
8. Ability to prioritize and organize multiple tasks amidst interruptions.