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JOB OBJECTIVE

This administrative position is responsible for coordinating provider enrollment for physician/allied health professional participation in all government and third party payers for all billing sites for which the division is responsible. Including other types of provider enrollments and provider credentialing tasks.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Prepares provider applications for government and third party payers.
• Coordinates correspondence to carriers and billing agent to expedite provider number assignments.
• Coordinates delivering provider applications to appropriate health plans. Includes adherence to strict deadlines and procedures.
• Performs follow-up with health plans in order to expedite participation approval by each health plan.
• Maintains systems to identify and disseminate to others regarding status of health plan participation.
• Troubleshoots miscellaneous information requests, claim questions, or requests arriving from insurance plans or billing agent.
• Interacts with colleagues to stay current on third party payer issues and topics.
• Coordinates with insurance carriers to maintain most current application and processes for enrollment.
• Resolve AR issues between carrier and billing agent that do not require provider intervention.
• Coordinates, completes, and follows-up on the revalidation process for contracted payers.
• Insures current information is on file for all contracted physicians and all pertinent documentation is forwarded to appropriate third party payers.
• Maintains all necessary provider number records in credentialing database.
• Other duties as assigned for enrollment.

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