Provider Enrollment Specialist

Position Summary: This position serves as the Provider Enrollment Specialist under the direct supervision of the Medical Staff Supervisor. This position is responsible for initiating provider and facility enrollment applications for Centers for Medicare and Medicaid Services (CMS), Arizona Medicaid (AHCCCS), California Medicaid (Medi-Cal), Nevada Medicaid, New Mexico Medicaid, and various private insurance or managed care plans. This position is responsible for completing revalidation and reenrollment requests from CMS, Arizona Medicaid, and other state Medicaid programs as required. This position ensures account information is maintained and updated for credentialing, insurance, and billing purposes. The Provider Enrollment Specialist is also responsible for assisting and/or managing various accounts which include registration, performance reporting, or performance attestation. Registration with PECOS for Medicare and state enrollment portals will be required for enrollment. Participation and performance include the CMS Merit-based Incentive Payment System (MIPS) program, State Quality Payment Programs, and other reporting systems as they become implemented. This list of duties and responsibilities is illustrative only of the tasks performed by this position and is not all-inclusive. Essential Duties & Responsibilities: • Serves as the provider authorized organizational official to review and complete CMS, state Medicaid, private insurance, and managed care applications. Submits applications once approved by the supervisor and/or administrator. • Serves as the liaison/facility point of contact for National Provider Identifier (NPI) and Provider Enrollment, Chain of Ownership System (PECOS) for all medical staff. Updating supervisor routinely of any issues. • Assist in managing all aspects of the Provider Enrollment program including developing and coordinating internal review systems to assure that both clinical and administrative activities are in compliance with agency, accrediting and regulatory requirements, and Medicare and Medicaid certification. • Initiates, revalidates, or re-enrolls provider or facility applications for CMS, state Medicaid programs (Arizona, California, Nevada, and New Mexico). Includes but not limited to obtaining all necessary documentation to complete an application (credentialing information, medical license(s), etc.), obtain signatures and submit. • Maintains and ensures provider and facility numbers for insurance and billing purposes are current. Includes but not limited to Drug Enforcement Administration (DEA) number, National Provider Identifier (NPI) number and Tax Identifier (TIN). • Works closely with the Medical Staff Supervisor and billing staff to ensure provider facility, and insurance information is accurate and complete in order for claim and accounts to receive maximum reimbursement. Assists, troubleshoots, and corrects problems that may arise with rejected claims. • Maintains records for provider and facility contracts and agreements and the integrity of highly confidential information. • Generates routine reports for compliance and internal audit processes. • Communicates orally and in writing with employees within the facility, state Medicaid programs, Medicare fiscal intermediaries, and CMS regarding enrollment processes or to ensure proper understanding of accurate data collection requests. • Attends meetings, trainings and conferences for Patient Business Services, CMS, and Medicaid as it relates to provider, facility, and insurance enrollment. • Assists with the collection of data for the CMS Merit-based Incentive Payment System (MIPS) program as defined by CMS for eligible professionals and hospitals. • Assists and supports medical staff to complete state Medicaid attestation and registration process by obtaining and organizing necessary reporting documents and website navigation. • Assists SMH and providers in adding or updating information for National Plan and Provider Enumeration System (NPPES, Medicare – Provider Enrollment, Chain and Ownership System (PECOS), Arizona AHCCCS incentive payment system (e-PIP), and CMS Identify & Access Management System (I&A). • Perform other duties as assigned that are related to this position. Other Skills and Abilities: • Positive working relationships with others. • Expertise in customer service. • Meticulous and organized, with strong attention to detail. • Excellent verbal and written communication skills; capable of maintaining multiple communication channels. • Moderate computer skills and literacy for communication, records, forms, ordering and statistical analysis. • Knowledge of company personnel policies and procedures Physical Demands: While performing the duties of this job, the employee regularly is required to sit; use hands to operate computer keyboard; reach with hands and arms; and talk or hear. The employee frequently is required to walk. The employee occasionally is required to stand, and stoop, kneel, crouch, or crawl. The employee must occasionally life and/or move up to 25 pounds. Work Environment: Work is generally performed in an office with moderate noise level. Extended hours and irregular shifts may be required.