Analyst, Healthcare Compliance
Microsoft 365
Provider Enrollment Representative - Remote IA, MN, ND, SD
Sanford Health
full-time
Posted on:
Origin: • 🇺🇸 United States • Iowa
Visit company websiteSalary
💰 $19 - $31 per year
Job Level
Mid-LevelSenior
About the role
- Monitor and maintain the process of gathering current, accurate, and complete information for provider directories and payor databases in compliance with regulations and payor requirements.
- Follow up with payors to obtain effective dates, status updates, and identification numbers for billing purposes.
- Update and maintain provider numbers and related data in both internal and external billing software and production programs.
- Maintain supporting documentation such as a W-9, CLIA certificate, bank, IRS, and CMS letters as applicable.
- Apply for or provide assistance with the application process for individual practitioner and/or facility national provider identifier (NPI) via national plan and provider enumeration system (NPPES).
- Notify payors and internal contacts of practitioner practice changes, including terminations, cases of malpractice, or other legal matters.
- Also will notify payors of site notification for payors (i.e., for new sites, site terminations, and changes).
- Perform account follow up on enrollment related denials and take the necessary action for account resolution in accordance with established federal and state regulations.
- Respond to internal and external inquiries regarding research issues.
- Review charges and claims pending report and/or claim edit work queues in Epic.
- May work Epic follow-up work queues to resolve enrollment-related issues.
- Keep current regarding any changes in managed care and other payor requirements for provider enrollment.
- Complete work within authorized time to assure compliance with strict departmental and compliance standards as well as payor time limits.
- Initiate enrollment for electronic claims submission.
- Attend site-planning meetings to provide input, gather necessary information for set up, and provide updates.
Requirements
- High school diploma or equivalent preferred.
- Previous experience as Billing Representative, Credentialing, or Provider Enrollment preferred.
- General computer skills, including proficiency with Microsoft products.
