Provider Enrollment Specialist
Provider Enrollment Specialist
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$ 23 - 28
1 Vacancy
Job Description
Closing Date: CLOSING DATE: April 21 2025 @ 4:00 P.M.(MST)
Salary Range: $23.52 $28.69/hour
**APPLICANT MUST HAVE A VALID UNRESTRICTED INSURABLE DRIVERS LICENSE**
**RESUMES AND REFERENCES ARE REQUIRED**
ESSENTIAL DUTIES FUNCTIONS AND RESPONSIBILITIES
Coordinates and ensures providers receive enrollment forms and packets where applicable responds to all inquiries regarding enrollment using timely and effective communication with providers programs and other credentialing staff.
Submits new provider enrollment applications via electronic online provider enrollment portals and will track online applications through all stages in order to accurately enroll each provider with commercial Medicare and State Medicaid payers.
Assist with updates and/or modifies provider enrollment for current and returning providers with Medicare and State Medicaid plans to ensure that all billable providers are appropriately linked to the correct facility. Maintains and recognizes effective processes for monitoring provider enrollment status for all commercial Medicare and State Medicaid health plans. Reviews and submits accurate enrollment applications.
Assists with submitting Medicare revalidations for Facility in a timely manner with Medicare to avoid loss of billing privileges.
Submits the Provider Contract Request Form along with other required documentation to Blue Cross Blue Shield (BCBS) and Tricare payers for all medical providers this is to ensure linking of medical providers to the Fort Defiance Indian Hospital Board Inc. Facility NPIs.
Communicates with other internal and/or external credentialing staff and supervisors on any deficiencies. Follows up on all submitted and outstanding documents for providers. Obtains all applications and supporting documents for State Medicaid Medicare and commercial plans from providers and keep on file electronically for audits purposes.
Maintain deadlines and enrollment schedules by tracking files through all stages of the enrollment process.
Assists providers with completing and updating of their Council for Affordable Quality Healthcare (CAQH) profiles.
Completes the provider turnaround document (TAD) to New Mexico Medicaid by deadlines scheduled by payers.
Notifies Medicare and State Medicaid Plans of the appropriate end date for exiting medical providers within 1 (one) year after departure.
Responsible for providing and updating a provider listing to the Director of Revenue Generation which consists of provider NPI information department title state licensure expiration dates start date and payers assigned provider numbers for active consulting and inactive providers. In addition to provide a weekly productivity summary report to direct supervisor.
Performs other duties as assigned.
MANDATORY MINIMUM QUALIFICATIONS:
Experience:
Two 2 years enrollment experience or two 2 years Revenue Cycle Management experience in
a healthcare environment
Education:
Associate Degree or equivalent experience
Please email degree or transcripts to
NAVAJO/INDIAN PREFERENCE:
FDIHB and its facilities are located within the Navajo Nation and in accordance with Navajo Nation law has implemented a Navajo/Indian Preference in Employment Policy. Pursuant to this Policy applicants who meet the minimum qualifications for this position and who are enrolled members of the Navajo Nation will be given primary preference in hiring and employment for this position and members of other federally recognized Indian tribes will be given secondary preference. Other candidates will be considered only after all candidates entitled to primary or secondary preference have been fully considered.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
