Overview:
Envision physician services is a multispecialty physician group and practice management companyEstablished in 1953, our organization provides anesthesia, emergency medicine, hospital medicine, radiology, primary/urgent care, surgical services, and women’s and children’s health services to hospitals and health systems nationwideSheridan healthcare, emcare, reimbursement technologies and emergency medical associates have recently joined forces to form envision physician servicesAs one organization, we now provide a greater scope of service than any other national physician groupOur collective experience from hundreds of local, customized engagements, culture of continuous lean process improvement, and team of experts in the business of healthcare enable us to better solve complex problems and consistently give healthcare organizations confidence in our executionOur combined organization serves more than 780 healthcare facilities in 48 states and the district of columbia.
If you are looking for a stable, fast paced, growing company in the healthcare industry that is committed to innovation, excellence, and integrity, then this may be a great next step in the advancement of your career.
Responsibilities:
We currently have an exciting opportunity for a provider enrollment specialist iii focused on maintenance for our nationally based provider enrollment team.
A local presence in raleigh, nc is preferredWith the right qualifications, this position may be staffed remotely.
Essential duties and responsibilities
Complete system set ups required to support enrollment activities, including, but not limited to, account set up, plan linkage, and authorized officials.
Collaborate with managed care to ensure that when new contracts and/or plans are added; that the payer is in the system, linked to applicable account(s), required forms are provided to add, roster requirements are obtained and shared, possibly participate in completing activities required to enroll existing providers, and communicate updates to provider enrollment leaders and associates.
Ensure medicare group enrollment and maintenance of same is completed accurately and timelyThis includes initial enrollment, management of required notification of changes, including, but not limited to, change in information, change in ownership, accurate service locations and terminationsThis includes oversight and validation of participation status and accuracy of information for internal and external vendors as well as mergers and acquisitions.
Collaborate with legal, compliance and others to maintain accurate organizational charts required for enrollment and ensure that internal and external stakeholders and payers are updated accordingly.
Complete auditing for internal and external vendors, document, summarize and communicate findings, along with remediation recommendations, participate in re-education and mitigation strategies, and continuously monitor for improvement.
Actively participate in on-going educational offerings such as, but not limited to, cms and medicare administrative contractor and state medicaid listservs, pecos advisory committee and edpmaSummarize and share information learned, possible impact to organization and/or external vendors, provide recommendations, partner with functional area leaders and instructor to communicate and implement process change as needed.
Manage and maintain governmental payer website access for internal and external users.
Complete all maintenance activities including research, recording, communication & information sharing, submission, confirmation and follow maintenance activities include, but are not limited to:
Medicare & medicaid revalidations
Recredentialing for all payers
Creation and maintenance of caqh practice and clinician profiles
Submission of clinician updates e.g., licensure and certificates of insurance to payers
Completion of any/all requests for data validation from payers and internal customers
Manage roster submission, review, and data entry
Demographic and other reportable changes, including, but not limited to, terminations, change of ownership, and change of information
Collaborate with colleagues and external vendors to resolve enrollment related denials
Partner with analyst to communicate any form updates required
Occasional overtime and/or participation on special projects may be required
Adhere to information security policies and ensure envision is as secure as possible.
Other duties as assigned.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorilyThe requirements listed below are representative of the knowledge, skill, and/or ability required.
Demonstrate a systematic approach to carrying out assignments; methodical in planning and performing; effective prioritization is required.
Perform with a high degree of accuracy and compliance; give meticulous attention to detail.
Communicate clearly, concisely, positively, and professionally.
Must be comfortable in a work-from-home environment.
Must meet company basic standards for working remotely.
Education/experience
High school diploma or general education degree (ged); some college preferred; and 3+ years’ experience as detailed above; or equivalent combination of education and experience as previously described in a fast paced, dynamic healthcare environment
2+ years’ experience with government healthcare payors
Microsoft office suite or office 365
If you are ready to join an exciting, progressive company and have a strong work ethic, join our team of experts! we offer a highly competitive salary and a comprehensive benefits package.
Envision physician services uses e-verify to confirm the employment eligibility of all newly hired employeesTo learn more about e-verify, including your rights and responsibilities, please visit www.dhs.gov/e-verify.
Envision physician services is an equal opportunity employer.
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