Medical Calling
Medical Calling
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Job Description
Key Responsibilities:
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Payer Enrollment Management:
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Oversee the enrollment and revalidation process for healthcare providers with various payers.
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Prepare submit and track enrollment applications to ensure timely approval.
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Verify the accuracy of provider information including NPI tax ID licenses and certifications.
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Compliance and Documentation:
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Ensure compliance with federal state and payer-specific regulations.
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Maintain up-to-date knowledge of payer requirements and enrollment guidelines.
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Organize and maintain accurate records of enrollment documents and correspondence.
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Issue Resolution:
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Investigate and resolve complex enrollment issues including application rejections delays or discrepancies.
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Liaise with payers providers and internal teams to address and resolve enrollment-related challenges.
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Process Improvement:
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Identify inefficiencies in the enrollment process and recommend improvements.
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Develop and implement best practices to streamline enrollment workflows.
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Monitor enrollment timelines and ensure deadlines are met.
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Training and Support:
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Provide guidance and mentorship to junior enrollment staff.
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Conduct training sessions on payer enrollment processes and systems.
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Serve as a subject matter expert for internal and external stakeholders.
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Reporting and Analysis:
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Generate reports on enrollment status trends and metrics.
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Analyze data to identify patterns and areas for improvement.
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Communicate enrollment progress and challenges to leadership.
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Qualifications & Experience:
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Bachelors degree in healthcare administration business or a related field (preferred).
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3 years of experience in payer enrollment credentialing or healthcare administration.
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In-depth knowledge of payer enrollment processes including Medicare and Medicaid.
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Familiarity with CAQH NPPES and other enrollment platforms.
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Strong understanding of healthcare regulations and compliance requirements.
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Excellent organizational communication and problem-solving skills.
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Proficiency in Microsoft Office Suite and enrollment software.
Preferred Skills:
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Certification in provider credentialing (e.g. CPCS CPMSM).
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Experience with electronic health records (EHR) and practice management systems.
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Ability to manage multiple priorities in a fast-paced environment.
Employment Type
Full Time
