Senior Provider Enrollment Representative | PFS Revenue

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: Sanford Business Center Building

Location: Sioux Falls, SD

Shift: 8 Hours - Varied Shifts

Job Schedule: Full time

Weekly Hours: 40.00

Job Summary

Serves as the subject matter expert for provider enrollment activities and inquiries. Functions as a resource for enrollment representatives and billing personnel relative to HIPAA related standards. Work collaboratively with providers to facilitate issues resolution, new facility and specialty enrollments, terminations, and revalidations. Coordinate with providers to determine if assistance or training is needed in order to complete enrollment process. Works with clearinghouse enrollment and denials. May generate, analyze and develop billing reports. May participate in unplanned special projects i.e. CRNA transition; new facility acquisition enrollment, etc. Provide backup support for training to the Lead Provider Enrollment Representatives and CAQH (universal database) provider training. Provide email support to billing staff for questions pertaining to denials. Assist enrollment staff in monitoring work queues and assist in denial resolution. May generate, analyze and develop billing reports as needed. Assist in special reporting needs and the maintenance of an enrollment dashboard report. This includes quality reporting on outcomes of staff enrollments. Conduct trend analysis, appeals and resolve low payment or underpaid accounts. Perform account follow up on enrollment related denials and take the necessary action for account resolution in accordance with established federal and state regulations. Understand edits and appropriate department procedures to effectively submit and/or correct errors on claims. Process and resolve complex denials and high dollar claim issues. Handle difficult account situations and resolve issues delaying or preventing payments from payers. Must be accessible to other departments upon demand for inquiries. Use advanced knowledge and understanding to process payor rejections. Provides input for payer-specific meetings. Analyze and review accounts to identify procedural inefficiencies and recommend improvements. Complete work within authorized time to assure compliance with departmental standards and payor timely limits. Other duties and special projects as assigned by the Supervisor, Manager or Director.

Department Details

This position has the potential to work from home after meeting department goals, quality and productivity. Hours are flexible between 7 a.m. and 7 p.m., Monday through Friday.

Qualifications

High school degree required, Associate's degree preferred.
Minimum one year experience as a Provider Enrollment Representative required.
Sanford is an EEO/AA Employer M/F/Disability/Vet.
If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to talent@sanfordhealth.org .

Job Function: Revenue Cycle

Req Number: R-31764

Featured: No