Provider Enrollment Representative | Patient Financial Services
Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
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Facility: 45th St Business Center - PFS
Location: Fargo, ND
Shift: 8 Hours - Day Shifts
Job Schedule: Full time
Weekly Hours: 40.00
Responsible for ensuring the timely enrollment of new providers with payors as well as new facility sites. Responsible for the on-going maintenance of existing providers and facility sites including re-enrollment and maintaining terminations. Monitor and maintain the process of gathering current, accurate, and complete information for provider directories and payor databases in compliance with regulations and payor requirements. Follow up with payors to obtain effective dates, status updates, and identification numbers for billing purposes. Update and maintain provider numbers and related data in both internal and external billing software and production programs. Maintain supporting documentation such as a W-9, CLIA certificate, bank, IRS, and CMS letters as applicable. Apply for or provide assistance with the application process for individual practitioner and/or facility national provider identifier (NPI) via national plan and provider enumeration system (NPPES). Notify payors and internal contacts of practitioner practice changes, including terminations, cases of malpractice, or other legal matters. Also will notify payors of site notification for payors (i.e., for new sites, site terminations, and changes). Perform account follow up on enrollment related denials and take the necessary action for account resolution in accordance with established federal and state regulations. Respond to internal and external inquiries regarding research issues. Review charges and claims pending report and/or claim edit work queues in Epic. May work Epic follow-up work queues to resolve enrollment-related issues. Keep current regarding any changes in managed care and other payor requirements for provider enrollment. Complete work within authorized time to assure compliance with strict departmental and compliance standards as well as payor time limits. Initiate enrollment for electronic claims submission. Attend site-planning meetings to provide input, gather necessary information for set up, and provide updates.
High school degree required, Associates degree preferred.
Previous experience as Billing Representative, Credentialing, or Provider Enrollment preferred.
Sanford is an EEO/AA Employer M/F/Disability/Vet.
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Job Function: Revenue Cycle
Req Number: R-31052