• Oversee issue resolution for the provider education process regarding application completion and submission
• Oversee and ensure that the collection, updating and maintenance of necessary provider information and documentation is completed
• Oversee and ensure that the enrollment follow-up, by client and payer, is completed within departmental and client parameters
• Ensure that provider enrollment applications for all initial applications and re-credentialing are completed in a timely and complete manner
• Ensure verification of provider and group information with insurance companies is completed
• Ensure that the information for enrollment and termination of all providers is accurate and communicate to team and clients as appropriate.
• Implement and maintain client and Company Q/A standards and protocols and coordinate with department manager quarterly reporting of same
• Act as the point of contact to the client to troubleshoot any issues and escalate as needed to management
• Contribute to the departmental process and procedures with a collaborative approach
• Monitor mPower and other provider reports to ensure they are kept current and report any deficiencies in same
• Assist in the training and education on enrollment processes or required research for accuracy, ensuring that all training activities are complete and up to date
• Document and record training sessions to be used for future reference
• Monitor and analyze productivity along with performing Q/A for all staff
• Provide timely feedback to offshore provider enrollment regarding Q/A process and results
• Identify struggles with Provider Enrollment staff and provide guidance when needed globally
• Performs other duties as requested
• Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Understand and comply with Information Security and HIPAA policies and procedures at all times
• Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties
  
  

• High school diploma or equivalent required
• Minimum 1 year experience in Provider Enrollment required
• Knowledge of and experience in healthcare billing preferred
• Experience with CAQH required
• Microsoft Office Suite knowledge/use required
• Strong interpersonal skills, ability to communicate well at all levels of the organization
• Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses
• High level of integrity and dependability with a strong sense of urgency and results oriented
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction
• At least twelve (12) months tenure in Med-Metrix and current role
• Annual performance review rating of 3.0 (Meets Expectations) and last three (3) consecutive months scorecard of at least 3.5 (Meets Expectation) with all KPIs passing
• No Level 3 and above sanction for one (1) year prior to application
  
  

• Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.
• Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress.
• Work Environment: The noise level in the work environment is usually minimal.
  
  

Please refer to job description.