Provider Enrollment Coordinator (Hybrid - Dallas)

Integrative Emergency Services; Dallas (TX); Hybrid; USD 52,000 - 72,000; Full time

Job summary

Integrative Emergency Services (IES) is seeking a Provider Enrollment Coordinator to manage payer enrollment for provider groups and individuals across government and commercial plans. This hybrid role requires 3 days in the Dallas office at 4835 LBJ Fwy, Dallas, TX 75244.

You will complete CAQH applications, maintain CAQH reporting, submit electronically to payers, and coordinate with in-house and external billing teams to maximize enrollment and timely reimbursements while upholding payer

Qualifications

• Verbal and written communication skills are essential for coordinating with clinicians, payors and staff.
• Attention to professionalism and tact in all interactions.
• Ability to build and maintain relationships with payors to facilitate enrollment.

Responsibilities

• Completes CAQH applications for new and existing providers; maintains reporting and attests every 120 days.
• Follows established enrollment procedures and coordinates with Enrollment Coordinators.
• Prepares applications for new providers across sites, payers and states with attention to detail.

Skills

Verbal and written communication

Professionalism and tact

Relationship building with payors

Tools

CAQH

Job description

IES DISCOVER IES

Integrative Emergency Services (“IES”) LLC, is a physician founded, owned, and led company whose goal is to empower physician leaders to create the best places to give and receive care. We are a clinically integrated and outcomes-based organization with a commitment to doing the right thing for our clinicians, patients, and communities. Through our commitment to patient care and reinvestment in our physicians, IES has a proven track record of improving patient outcomes and producing results that uphold the hospitals' reputations in which we operate. We strive to create a culture of continuous improvement, community, and recognizing our Physician leaders. To learn more, visit our website IES.Healthcare and click to see a highlight of our 12th Annual Quality Summit.

POSITION SUMMARY

Integrative Emergency Services, LLC ('IES') is looking for a Provider Enrollment Coordinator to support the division in facilitating the enrollment (payer applications) of both the Provider Groups and individual providers with the various government and commercial health insurance plans, network managed care contracting plans, and third-party billing entities that require provider enrollment. This includes CAQH maintenance. This position is also responsible for the A/R on hold, pending provider number assignment, from the payers. Role will be Hybrid format 3 days in office at 4835 LBJ Fwy, Dallas, TX, 75244.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Includes the following. Others may be assigned.

• Completes CAQH applications for new and existing providers. Will maintain CAQH reporting and attest provider applications every 120 days.
• Following established enrollment procedures and sound practices directly or by working with Enrollment Coordinators.
• Prepares applications for new providers for multiple contracts sites, payers, and states requiring an acute attention to detail, accuracy and knowledge of complex and varied requirements.
• Submit applications electronically to payers based on contracts. Track and follow up on a timely basis to ensure completion of application process and submission to payer for approval.
• Extensive and frequent verbal and written communications with Clinicians, state payers, insurance carriers, third party billing company and internal company staff requiring professionalism and tact to attain or provide all needed information quickly in order to expedite the enrollment of Clinicians in the various plans to maximize billing opportunities.
• Acts proactively and builds strong relationships with payors to facilitate enrollment and obtain provider billing numbers.
• Utilizes templates or prepares correspondence inserting proper provider and group related information for submission of applications to payers.
• Works with in-house and third-party Billing Company for current applications, system updates and identifying/resolving problems. Handles corrections or rejections of claims due to enrollmenterrors and/or claim submission requirements.
• Conveys issues and status of problems to Enrollment Manager.
• Ensures Held A/R enrollments are submitted on timely basis to avoid risk of claims/adjustments and an unnecessary increase of Held AR.Maintain and work reports of held A/R to maximize income opportunities.
• Accountable for meeting or exceeding divisional and/or corporate Enrollment performance standards and meeting time-sensitive deadlines as defined.
• Update status of application in system databases and in excel reports for accurate reporting.
• Works independently within the scope of responsibility and authority. Understands and follows state and payer requirements, some of which are quite complex, and determines which applications require management approval or special processing requirements.