RCM Provider Certification and Enrollment Specialist

Chandler, TX - USA

Monthly Salary: Not Disclosed

Posted on: 2 days ago

Vacancies: 1 Vacancy

Job Summary

Position location: You will be able to work remotely from your home location in the United States.

PURPOSE AND SCOPE:

This position is responsible for the provider credentialling and enrollment process associated with their ability to receive payment from Medicare/Medicaid.

State Medicaid application process
Medicare EDI enrollment.
ERA EFT Claims Enrollment
DDE and payer website access
Applications for specific non-network payors
Functions as a centralized group to best serve the Business for all enrollment needs. Provide visibility to the organization on the status of facilities during the enrollment processes. Cultivate and maintain a professional relationship with industry partners.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

- Follow Acquisition Joint Venture and DeNovo facility from rumor to completion (point of billing)
- Participate in the acquisition JV conversion and new facility calls
- Assists Regulatory with CMS 855 application issues & follow up
- Track completion of state license and CLIA
- Monitor for expiration of state licenses and provide current documents to State Medicaid
- EDI Enrollment with Medicare Administrative Contractor (MAC)
- Facility setup for Electronic Claims in Relay Health
- Establish connection with Corporate DSD EDI
- Add PTANs to MDE transmission via Relay Health
- Complete Medicaid applications to include all required facility documents and managing employee Medicaid Disclosure Questionnaires (MDQ). Work with internal Regulatory and Legal teams to ensure all disclosure information is current and accurate
- Document management - KIMA/ExtraView and the EDS Team SharePoint site
- Medicaid Re-credentialing
- Medicare PTAN Medicaid provider # and location addresses updates in Facility Database
- Facility relocation reporting to state Medicaid programs
- Revenue Center assignment in Big Wave system
- Medicare DDE enrollment and recertifications
- Establish/terminate Revenue Centers and Cash Departments access to all insurance payer websites
- Commercial payer enrollment for EFT ERA and electronic claims
- Reenroll commercial payors for ERA EFT Claims
- Tricare applications for non-network participation
- Blue Cross Blue Shield applications for out of network provider numbers.
- Create and maintain all W9s
- Other duties as assigned

Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION: High School Diploma required Associates degree strongly desired

EXPERIENCE AND REQUIRED SKILLS:

Minimum 1 year experience in medical accounts receivable
Provider credentialing experience strongly desired
Strong time management skills and the ability to juggle multiple tasks
High level of creativity innovation initiative and sense of ownership
Organizational capabilities and strong attention to detail
Self-motivated quick learner and independent thinker
Must be able to work well independently and in a team environment
Must be capable of quickly identifying issues and provide recommendations
Excellent verbal/written and communication skills
Proficient in MS Excel
Protect highly sensitive and confidential information

If your location allows for pay/benefit transparency please click the link below to request further information on this position. Pay Transparency Request Form ()

Fresenius Medical Care maintains a drug-free workplace in accordance with applicable federal and state laws.

Fresenius Medical Care is an equal opportunity employer and does not discriminate on the basis of race color religion sexual orientation gender identity parental status national origin age disability military service or other non-merit-based factors

Required Experience:

Position location: You will be able to work remotely from your home location in the United States.PURPOSE AND SCOPE:This position is responsible for the provider credentialling and enrollment process associated with their ability to receive payment from Medicare/Medicaid.State Medicaid application p...