Lead Provider Enrollment Representative - Provider Enrollment
Job Title: Lead Provider Enrollment Representative | Provider Enrollment | Multi-City
Department *: * Provider Enrollment
Job Schedule: Full Time
Hours Per Shift: 8 hr
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.
Coordinates the delivery of training sessions and their associated activities. Anticipates obstacles, barriers or gaps that would impact the efficiency of work and activities. Coaches team members in applying methodologies for quality assurance. Establishes and maintains productive working relationships within and outside of own area. Mentors others in their technical areas and shares expertise on critical issues. Provides the team with necessary resources as well as the emotional and technical support needed to produce quality work. Adheres to established internal standards and procedures abstracted from HIPAA. Uses a variety of computer hardware, operating systems, utilities and applications. Demonstrates in-depth knowledge of organization's policies and practices requiring confidentiality. Works with processes and tools for capturing and reporting performance data.
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.
About Sanford Health:
At Sanford Health, we are dedicated to the work of health and healing.
Every day, we show that commitment by delivering the highest quality of care to the communities we serve.
We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care,
leading-edge technologies and world-class facilities.
In addition to strong clinical care, we are also committed to research,
education and community growth. We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases.
We continuously seek new ways to achieve our vision of improving the human condition
here in your community, across the region and around the world.
The entire team at Sanford Health recognizes the value of healthy families
and communities. We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.
Sanford is an EEO/AA Employer M/F/Disability/Vet.
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Job Function: Revenue Cycle
Job Schedule: Full Time
Req Number: WD02465