Position Summary:
The Provider Enrollment Specialist is responsible for ensuring that all forms of enrollment are completed in a timely fashion enabling individual practitioners and facilities to meet all billing and reporting requirements for commercial, state, and government agencies

Qualifications:
EDUCATIONAL REQUIREMENTS
Associates Related Field or Five (5) years relevant experience.

CERTIFICATION & LICENSURE REQUIREMENTS
None specified

EXPERIENCE REQUIREMENTS
One (1) year of general administrative services experience in addition to education requirements. Proficiency in all PC and Microsoft Office Suite Applications, including database management, internet research, and other applications as needed.

SKILLS AND KNOWLEDGE
Extremely detail oriented, with the ability to multi-task and follow through to meet established deadlines. Outstanding written and verbal communication skills with ability to work with all levels of staff and third parties to problem solve and accomplish positive outcomes. Ability to develop and put in place process improvements that increase efficiencies.

Essential Functions:

• Assemble and complete all Center for Medicare and Medicaid Applications via either PECOS (internet-based Provider Enrollment, Chain and Ownership System) or the paper application for all lines of business (CPG, CFH and HRHC).
• Monitor, document and communicate status of individual applications so claims can be appropriately released for billing.
• Complete or assign to third party consultant all other CMS related applications and change notifications related to system entities and/or locations.
• Monitor and update revalidations for individuals and entities.
• Complete all other enrollment forms for federal and non-federal payors as needed, including roster updates and Electronic Funds Transfer forms with bank account information for incoming claim payments.
• Apply for NPI (National Provider Identifier) for all lines of business and individual providers via online or paper submission process.
• Ongoing education and on-line seminars to keep up with current processes required by CMS and IDPH.
• Submission and attestation for Meaningful Use programs for individual providers and entities. This includes tracking of attestations and incoming funds to confirm completeness of receipts from Medicare and Medicaid.
• Maintain proficiency in Medical Staff Office credentialing software (MSOW) as wells as maintaining provider lists for internal usage and third parties.
• Maintain Provider Enrollment Information and Procedure Manual with regular review and updates, as needed.