Revenue Cycle Management EDI Enrollment Specialist
Welcome to the new standard of healthcare!
Premise Health is the world’s leading healthcare access provider. We deliver purpose-driven career experiences in a culture-centric work environment—ensuring that employees at the nation's best companies get, stay, and be well. In a changing healthcare environment, we know there's a better way for organizations to help their people live healthier lives by delivering the right care at the right time, right where they work. Partnered with visionary organizations around the globe, we offer a broad range of healthcare services and deliver an effortless patient experience that raises the bar, lowers costs, and redefines the meaning of quality care. By shifting the conversation from cost to return and from treatment to prevention, we are committed to help people, their families, and the organizations they work for be at their best.
We are looking for a Revenue Cycle Management EDI Enrollment Specialist to work at our Corporate office in Brentwood, TN! If you possess a “whatever it takes attitude” keep reading.
It’s hard to pinpoint a “typical” day here (and who wants typical anyway?), but as the EDI and Enrollment Specialist (EES) manages provider enrollment for all new and existing clients as well as obtaining and managing all Location NPIs and assigning tax IDs to each. The role develops, coordinates, implements, and manages all payer/EDI-related processes for assigned regions. Additionally, the EES serves as the primary link between the Premise and any claims/payer data-trading partners.
The purpose of the EES’ job is to ensure all items are accurately obtained, tracked, setup, updated, and communicated for each implementation and/or payer/provider change.
What You’ll Do for Us:
- Obtains and tracks all location NPIs for new EPIC implementations
- Completes all documents and tracks process for billing providers and/or group enrollment with applicable payers
- Maintains and updates all provider CAQH accounts
- Registers new sites, staff, providers, and RCM Account Managers with Navinet, Availity and One Health Port
- Works with operations and providers on enrollment and contracting essentials needed for completion and sign-off
- Manages the processes associated with new and change payer set ups as it relates to 270/271 eligibility, 837/835 files, and EFT’s
- Responsible for updating workflow processes and documentation related to enrollment
- Meets all deadlines for implementations, changes, and updates
- Communicates progress of implementations, changes, and completion to leadership as it relates to enrollment (payer, Navinet, Availity, One Health port and CAQH) and location NPIs
- Serves as SME for RCM as it relates to billing issues around provider and/or group payer enrollment
- Collaborates with other Revenue Cycle staff, Operations, Providers, Legal, and Leadership Teams
- High School Graduate, minimum education requirement or equivalent work experience
- A minimum of 2 years of experience working with EDI or enrollment platforms, required
- Experience working with multiple different carrier specifications, required
- A minimum of 2 years of experience credentialing/provider enrollment and/or payer contracting, required
- A minimum of 2-3 years of experience in billing and collections revenue cycle, preferred
Knowledge and Skills:
- Demonstrated successful physician third party billing leadership experience
- Possesses strong analytical, problem solving, and decision-making skills
- Effectively utilizes Microsoft Office tools (Excel, Word, and PowerPoint)
- Highly developed written and verbal communication skills
- Knowledge of CPT and ICD10 coding, preferred
- Background working in practice management system(s).
- Knowledge and use of EPIC preferred
- Attention to detail and highly effective planning, organizational, time management, and prioritization skills
- Must be able to work independently in a manner to achieve goals, objectives, and productivity requirements.
What We’ll Do for You:
At Premise Health, you’re not an employee – you’re a team member. We have health centers, pharmacies, fitness centers and offices scattered across the country, but we’re all working together to deliver exemplary and delightful service to our clients, their employees and family members. We’re proud of the culture we’ve built, and we aim to assist our team members in living their best life – in and out of the workplace. That’s why you’ll find us taking a yoga class together or starting a book club. We know that we can only help people get, stay, and be well if we do the same for ourselves. We’re also not afraid to share what we’re up to – check out some of our smiling faces.
As an employer, we want to compensate you for the work you do with more than a paycheck (although you’ll get one of those too). Premise Health offers competitive benefits packages including medical, dental, vision, life insurance, 401(k), paid holidays and vacation time, and a company-sponsored wellness program. We are an equal opportunity employer of nice people and value inclusion at our company. We do not discriminate based on race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.