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Provider Enrollment Representative - Provider Enrollment

Employer
Sanford Health
Location
Fargo, North Dakota
Salary
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Industry
Healthcare
Role
Other
Job Type
Long-Term

Job Details


Job Title: Provider Enrollment Representative | Provider Enrollment | Fargo

City: Fargo

State: North Dakota

Department *: * Provider Enrollment

Job Schedule: Full Time

Shift: Varies

Hours Per Shift: 8 hr

JOB SUMMARY

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.

POSITION RESPONSIBILITIES

Uses a variety of computer hardware, operating systems, utilities and applications. Easily copes with day-to-day frustrations, adversities and uncertainties. Under guidance, deals with situations or information requiring confidentiality. Researches business related data and generates and interprets basic analytics. Delivers work quality and quantity in addition to meeting deadlines. Responds to questions from providers and provides instructive support, if necessary. Identifies own key assignments, schedules, and process steps. Review records for completeness, accuracy, and compliance with regulations. Recognizes changing demands and priorities; validates changes with management. Retrieves and uses the data of healthcare information systems correctly and legally.

DEPARTMENT DETAILS

The hours for this position are 8:00 am - 4:30 pm, Monday - Friday. This position can sit in Sioux Falls, SD or Fargo, ND.

QUALIFICATIONS

High school degree required, Associates degree preferred. Previous experience as Billing Representative, Credentialing, or Provider Enrollment preferred.

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.
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 .

City: Fargo

State: North Dakota

Job Function: Revenue Cycle

Job Schedule: Full Time

Shift: Varies

Req Number: WD03902

Company

Sanford Health is excited to be on a journey of tremendous growth and momentum. With our vast geography, cutting-edge medicine, sophisticated research, advanced education and our own health plan, we are unique in what we do and how we do it. Through relationships built on trust and successful performance and a vision to improve the human condition, Sanford seeks to make a significant impact on health and healing. With a commitment to diversity and inclusion, our journey as an organization includes continually building on the diverse talents, experiences and beliefs of our employees, as well as the patients and communities we serve. We are proud to be from the Midwest and to impact the world. We look forward to joining with you in the journey.

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