Government Enrollment Specialist – Remote

AdventHealth Corporate

All the benefits and perks you need for you and your family:

• Benefits from Day One

• Career Development

• Whole Person Wellbeing Resources

• Mental Health Resources and Support

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Shift : Monday-Friday

Job Location : Remote

The role you’ll contribute:

Coordinates the day-to-day administration of Adventist Health System’s (AHS) Medicare and Medicaid provider enrollment program, ensuring that all existing and new physicians and other billing health care providers in the AHS system are enrolled in compliance with all affiliation and participation requirements, as well as regulatory and internal policy requirements.

The value you’ll bring to the team:

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES:

• Monitors and coordinates the Medicare/Medicaid application approval process (including out of state) for all new AHS physicians and credentialed mid-level health care professionals and ensures provider files are current and noted in detail in the system of record.

• Monitors data collection, and reviews and evaluates quality of all provider information received through the application process acquires additional information as necessary, and verifies documentation in accordance with established policies and procedures.

• Achieves productivity standards as determined by management secures provider effective dates and enters them into Athena to release claims within 2 business days of notification.

• Identifies and reports any situations or issues regarding new or current providers that may have potentially adverse implications with respect to Medicare/Medicaid reimbursements recommends solutions and/or courses of action to be taken and coordinates action with interested departments.

• Coordinates the administration of processes designed to ensure compliance with established financial and operating objectives, AHS policies, and legal requirements as they relate to provider professional billing for Medicare/Medicaid.

• Maintains and ensures the on-going accuracy and organization of aspects of the billing system data dictionaries as they relate to Medicare/Medicaid billing disseminates procedures and materials to ensure accurate and efficient data collection.

• Maintains currency of knowledge on Medicare/Medicaid provider requirements in all states that AHS has provider medical groups ensures that provider initial certification and re-certifications for Medicare/Medicaid are continually up to date with respects to out of state requirements.

• Coordinates the processing and data entry of new physician applications for Medicare/Medicaid billing purposes, and follows up as necessary to ensure accuracy and compliance with all applicable AHS policies and procedures.

• Attends meetings relative to the physician approval process as requested provides guidance and support, and serves as a resource on related process issues as appropriate.

• Acts as a primary point of contact for all internal and external constituencies on day-to-day administrative matters associated with the Medicare/Medicaid participation process troubleshoots and resolves problems as they arise.

• Facilitates and assists with internal and external audits as appropriate.

• Performs miscellaneous job-related duties as assigned.

KNOWLEDGE AND SKILLS REQUIRED:

• Attentive to detail and accuracy strong organization skills required.

• Working knowledge and understanding of all rules, regulations, policies, and procedures with regard to health care professional billing under Medicare/Medicaid.

• Ability to communicate effectively, both orally and in writing.

• Analytical, evaluative, and critical thinking skills.

• Knowledge and understanding of electronic data collection and data management systems and procedures.

• Ability to prioritize and manage a demanding workload.

• Working familiarity with Medicare/Medicaid provider billing requirements in all states where AHS has provider medical groups.

• Knowledge of AHS medical practice billing procedures and systems as they relate to Medicare/Medicaid.

• Skill in the use and administration of specialized electronic medical billing applications.

• Strong interpersonal skills and ability to work effectively at all levels in a collaborative team environment.

Qualifications

The expertise and experiences you’ll need to succeed:

EDUCATION AND EXPERIENCE REQUIRED:

• High school diploma or GED

• Minimum 3 years of credentialing or provider enrollment experience

• Completed degree(s) from an accredited institution that are above the minimum education requirement may be substituted for experience on a year for year basis.

EDUCATION AND EXPERIENCE PREFERRED:

• AS Degree in healthcare

REQUIRED COMPETENCIES

• Achieves Results: Reflects a drive to achieve and outperform, continuously looking for improvements, and accepts responsibility for actions and results.

• Communication Skills: Exhibits excellent oral and written communication skills.

• Knows the Business: Understands how the business works and can identify sources of value, efficiency, and effectiveness.

• Manages to Result: Contributes to the successful realization of goals and demonstrates accountability for goal realization.

• Service Orientation: Listens to and understands the customer, anticipates customer needs, and gives high priority to customer satisfaction.

• Subject Matter Expertise: Possesses deep knowledge and specialized skill set pertaining to the job function.

Teams with Others: Creates an environment that values individual perspectives while driving towards common goals assists teammates as necessary.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Managed Care

Organization: AdventHealth Corporate

Schedule: Full-time

Shift: 1 – Day

Req ID: 23034887

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.