Provider Enrollment Specialist - Full time - Detroit

Provider Enrollment Specialist - Full time - Detroit Detroit, MI Job Details Full-time 1 day ago Benefits Health insurance Dental insurance Tuition reimbursement Qualifications Computer operation Customer communication Microsoft Excel Microsoft Outlook Computer literacy Research Mid-level High school diploma or GED Analysis skills Quality improvement Data entry Data collection Epic Healthcare data collection Quantitative analysis Associate's degree Medical claim denial management 2 years Healthcare compliance Communication skills File organization Full Job Description

GENERAL SUMMARY

Under general supervision, responsible for all functions relating to ensuring that all appropriate practitioners are enrolled in government programs and commercial health plans. Primary responsibilities include taking a new provider application from receipt to inclusion in directory and making ongoing updates. Responsibilities include data entry, data collection, analysis of information collected for appropriate enrollment. The Provider Enrollment Specialist must be knowledgeable to work in all aspects of the insurance provider enrollment process including initial enrollment, re-credentialing or revalidation. Provider Enrollment Specialist ensures providers are enrolled in accordance with current standards and regulations and must maintain stringent compliance with payers. The Provider Enrollment Specialist maintains excellent relations and is the main liaison between payers, clinics, and providers to assure participation status is managed in a timely and accurate manner.

PRINCIPAL DUTIES AND RESPONSIBILITIES

Responsible for comprehensive and precise data entry for maintaining the accuracy of the enrollment database Responsible for following department database standards for the documentation of all health plans and products, documents, and notes on incoming and outgoing attempts to obtain information and follow up conversations. In depth working knowledge of various payor applications associated with the workflow process, i.e., Webdenis, CHAMPS, PECOS, CAQH. Follows the Network Management workflow process in real time meeting required turnaround times and accuracy rates. Verifies all required information and obtains necessary documents to ensure providers are processed according to current policies and procedure and ensure all files have a welcome, denial, or term letter, as appropriate. Facilitates research and resolves denied claims & enrollment issues. Possesses in depth knowledge of health plan standards and department operating procedures and effectively communicates issues, trends, concerns among team members and interdepartmental customers. Communicates with internal and external customers in a clear, concise and professional manner to obtain or provide necessary information. Organize and maintain practitioner files following confidentiality guidelines. Participates in system integration and continuing quality improvement efforts. Provides support and problem solving to Department Director in the development of short and long-range plans for the department, assuring overall continuity of the corporate strategic.

EDUCATION/EXPERIENCE REQUIRED

High School Diploma required. Associate's Degree preferred. 2 - 5 years of provider enrollment provider billing or credentialing experience required. High level of energy to work in a fast paced constantly changing environment often including time deadlines, frequent interruptions, multiple demands and multi-tasking. Ability to work under minimal supervision. Ability to perform detail work efficiently and with a high degree of accuracy. High organized. Strong business acumen. Excellent verbal and written communication skills. Ability to interpret information and make judgments quickly. Ability to interact professionally with practitioners and other external customers Strong quantitative and analytical skills. Computer proficient in Microsoft Office including: Outlook, Word and Excel. Proficient in EPIC, Morrisey.

CERTIFICATIONS/LICENSURES REQUIRED

None

WORK ENVIRONMENT

Works in a normal office environment where there is no physical discomfort due to temperature, dust, noise, and the like. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions Additional Details This posting represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described above. Overview Henry Ford Health partners with millions of people on their health journey, across Michigan and around the world. We offer a full continuum of services - from primary and preventative care to complex and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and other health care retail. With former Ascension southeast Michigan and Flint region locations now part of our team, Henry Ford's care is available in 13 hospitals and hundreds of ambulatory care locations. Based in Detroit, Henry Ford is one of the nation's most respected academic medical centers and is leading the

Future of Health:

Detroit, a $3 billion investment anchored by a reimagined Henry Ford academic healthcare campus. Learn more at henryford.com/careers. Benefits The health and overall well-being of our team members is our priority. That's why we offer support in the various components of our team's well-being: physical, emotional, social, financial and spiritual. Our Total Rewards program includes competitive health plan options, with three consumer-driven health plans (CDHPs), a PPO plan and an HMO plan. Our team members enjoy a number of additional benefits, ranging from dental and eye care coverage to tuition assistance, family forming benefits, discounts to dozens of businesses and more. Employees classified as contingent status are not eligible for benefits. Equal Employment Opportunity/Affirmative Action Employer Equal Employment Opportunity / Affirmative Action Employer Henry Ford Health is committed to the hiring, advancement and fair treatment of all individuals without regard to race, color, creed, religion, age, sex, national origin, disability, veteran status, size, height, weight, marital status, family status, gender identity, sexual orientation, and genetic information, or any other protected status in accordance with applicable federal and state laws.