JOB DESCRIPTION OVERVIEW:
Under supervision of the Provider Enrollment Managers, the Lead Provider Enrollment Specialist oversees and directs the day-to-day activities of the provider enrollment team in support of department and organizational goals. Provider Enrollment is an integral part of a successful Revenue Cycle Operation and the Organization’s ability to meet financial goals, impacts patient satisfaction, and client retention.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Develop and maintain relationships with payers, clients, Corporate Managed Care to promote prompt resolution/leveraging of existing relationships to resolve open enrollment issues.
- Complete payer research for new payers, new state requirements, and ensure guidelines are known and train department members on same.
- Monitor accuracy of applications in ApGen and submit/manage changes as needed.
- Submit, track, follow up on need for and requests of retroactive consideration and prepare adjustment approvals.
- Serve as quality auditor for group and individual applications.
- Monitor group provider enrollment mailbox and proactively manage deficiencies. Determine root cause of deficiencies, implement corrective actions, document receipt of, ensure timely and accurate resolution of same.
- Support continuous improvement and automation of provider enrollment processes by collaborating with various stakeholders to develop new or enhance existing techniques, policies and procedures.
- Serve as back up to Roles 1, 2, or 3 as needed.
- Other duties as assigned.
Location/Region: Knoxville, TN (US)