Enrollment Specialist - Intermediate

  • Location

    Pasadena, United States

  • Sector:

    Business Professional

  • Job type:


  • Contact:

    Leric Arcigal

  • Job ref:


  • Published:

    over 1 year ago

  • Expiry date:


Job Description:Enroll Kaiser Permanente providers, practitioners and facilities with government programs. Assist the Provider and Facility Enrollment Coordinator and Management with Unit production. Major Responsibilities/Essential Functions 1. Enroll and terminate providers, practitioners and facilities with CMS and other government programs by completing 855 series forms, gather credentials and associated documentation required for enrollment and process enrollment forms. Track status of in process enrollment forms until final approval received. 2. File provider/practitioner/facility ID numbers once assigned by governing agencies and perform system updates as appropriate. Maintain forms that meet the standards of state and federal legislation and accrediting body standards. 3. Partner with MAPMG and Health Plan Human Resources and Practitioner and Provider Quality Assurance to research and process internal or external requests regarding provider/practitioner licensure, credentials, and assigned ID numbers. Follow up on claim denials related to enrollment issues. 4. Attend MAPMG Orientation, obtain signature pages and schedule appointment with providers to perform online PECOS enrollment. 5. Communicate with providers/practitioners and other departments to escalate issues, share information and promote the process of obtaining documentation required for enrollment. Provide information and assistance to providers/practitioners. Ensure adequate follow-up is performed. 6. Responsible for end-to-end Revalidation letter process, download list from CMS, obtain comparison report from Medicare Provider Enrollment Database and schedule providers for online re-enrollment. 7. Utilize the reports within the Medicare Provider and Facility Enrollment Databases to monitor updates, promptly complete work orders and identify work to be completed. 8. Perform special projects, reconciliations, research, and analyses, as directed by Coordinator or Management. 9. Support activities related to internal and external audits of Unit. Respond to inquiries and provide information as requested. 10. Perform other related duties as assigned. Job Qualifications Minimum Education: High School Diploma is required or GED equivalent. Preferred Education: Associates Degree or equivalent years of Provider/Facility Enrollment or Credentialing experience preferred. Minimum Work Experience and Qualifications: 1-5 years of healthcare experience including Medicare or Medicaid Provider or Facility Enrollment or Credentialing experience required. Demonstrated proficiency with Microsoft Office Word, Excel and Access required. One year of Revenue Cycle operations and processes experience required. Minimum of two years of direct customer service experience required. Strong analytical, interpersonal, communication, conflict resolution, problem solving and organizational skills required. Proficiency with 855 series forms, PECOS and NPPES online systems required. Demonstrated excellent written and oral communications skills required. Ability to handle multiple tasks and meet required deadlines required. Ability to be thorough and follow through on detail required. Working knowledge of insurance regulations, as they pertain to provider enrollment with payors and government programs. Ability to maintain high level of accuracy in multiple databases and tracking spreadsheets containing confidential and secure information. Proven ability to work in a team setting as well as independently. Ability to use good judgment. Preferred Work Experience and Qualifications Medical Group and Health Plan knowledge preferred. Top Daily Responsibilities: -Assisting physician and non-physician practitioners with Medicare/Medi-Cal enrollment steps, including Identity and Access surrogacy - Processing data entry of approvals for I&A, Medicare and Medi-Cal transactions - Providing backup support to Project Analyst team Top (3) Required Skills Candidate Should Have: Customer service with a focus on providing service to physicians and other patient service providers - High accuracy with data entry - General knowledge and high comfort level with utilizing technology & web based software - Position requires both data entry and critical thinking and problem solving on the data being entered and responding to questions from customers, who cannot always articulate the issues.