Lead Provider Enrollment Representative - Provider Enrollment | PFS | SF or Fargo

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.
See yourself at Sanford!

Facility: 45th St Business Center - PFS

Location: Fargo, ND

Address: 300 45th St S, Fargo, ND 58103, USA

Shift: 8 Hours - Day Shifts

Job Schedule: Full time

Weekly Hours: 40.00

Job Summary

Serve as the subject matter expert for billing concerns and functions for enrollment representatives, other enterprise departments, as well as outside vendors. Serve as a resource for billing personnel relative to HIPAA related standards. Conduct orientation and training for new employees. Monitor trends and issues in order to facilitate root cause analysis and continuous process improvement for department. Identify ongoing staff training needs, conducting the appropriate training as needed. May perform CAQH training and assist in the revalidation reminders for providers if needed. Assist in creating or revising policies, procedures, standards and/or workflows as needed. Provide oversight and audit the quality of work produced, ensuring accuracy and compliance with established policies and procedures. Generate, analyze and develop billing reports. Manage special projects relevant to operational concerns and deliverables, coordinating all aspects to ensure successful results. 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. Analyze and review accounts to identify procedural inefficiencies and recommend improvements. Must be accessible to other departments upon demand for inquiries. Use advanced knowledge and understanding to process payor rejections. 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

Flexible Hours!
Work From Home Coming Soon!
OT Opportunities Available!

Qualifications

High school degree required, Associate's degree preferred.
Minimum two years experience as a Provider Enrollment Representative or one year experience as Senior Provider Enrollment Representative required.

Benefits

Sanford Health offers an attractive benefits package for qualifying full-time and part-time employees. Depending on eligibility, a variety of benefits include health insurance, dental insurance, vision insurance, life insurance, a 401(k) retirement plan, work/life balance benefits, sick leave and paid time off. To review your benefit eligibility, visit https://sanfordhealth.jobs/benefits .
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 .
Sanford Health has a Drug Free Workplace Policy. An accepted offer will require a drug screen and pre-employment background screening as a condition of employment.

Job Function: Revenue Cycle

Req Number: R-39136

Featured: No