[Hiring] Provider Enrollment Specialist @Ventra Health

Role Description

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 payers 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.

Qualifications

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

Requirements

• 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.

Equal Employment Opportunity

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 Agencies

Ventra Health does not accept unsolicited agency resumes. Ventra Health is not responsible for any fees related to unsolicited resumes.

Solicitation of Payment

Ventra Health does not solicit payment from our applicants and candidates for consideration or placement.

Attention Candidates

Please be aware that there have been reports of individuals falsely claiming to represent Ventra Health or one of our affiliated entities. These scammers may attempt to conduct fake interviews, solicit personal information, and, in some cases, have sent fraudulent offer letters. To protect yourself, verify any communication you receive by contacting us directly through our official channels. If you have any doubts, please contact us at [email protected] to confirm the legitimacy of the offer and the person who contacted you. All legitimate roles are posted on https://ventrahealth.com/careers/ .

Statement of Accessibility

Ventra 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/ .