Provider Enrollment Claims Specialist SR
Description
At SCP Health, what you do matters
As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.
Why you will love working here:
- Strong track record of providing excellent work/life balance
- Comprehensive benefits package and competitive compensation
- Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.
What you’ll be doing:
The Provider Enrollment Sr Claims Specialist directly impacts the financial stability of the Company because he/she is the SCP Health representative who researches and resolves the provider enrollment claim denials with Government and Commercial Payors and resolves large, complex payor related denials that may affect a large volume of claims. The Sr Specialist will also help train and work through higher level issues with the PE Claims Team and assist the Manager with special projects. Working in collaboration with the Provider Enrollment Team, the Provider Enrollment Sr Claims Specialist, using his/her knowledge of SCP Health policies in conjunction with insurance carrier billing and enrollment requirements works to correct issues that caused claims to deny and rebill corrected claims to receive payment for our providers’ services.
- Serve as the lead contact for Provider Enrollment claim denials with payors, SCP Medical Collections, Revenue Integrity, Systems, and Managed Care departments.
- Work to resolve high level, complex payor issues that require more in-depth knowledge of both medical billing and provider enrollment/credentialing.
- Work special projects as assigned by the Provider Enrollment Claims Supervisor or Manager
- Research Provider Enrollment related denials, front end rejections, and correspondence routed to the Claim Specialists assigned ETM Workflow views.
- Contact payors to get clear understanding of denial and changes needed to receive payment.
- Document all correspondence with payors in ETM Task note.
- Assist manager with training of new employees.
- Monitor changes to payor requirements through payor websites, bulletins, emails, etc and communicate any changes to Manager to ensure changes are made wherever applicable.
- Maintain production requirements determined by Manager.
- Maintain audit score average determined by Manager.
- Daily contact with payors
- Daily contact with Department Leadership
- Frequent contact with other SCP Health Departments
Who/What we are looking for:
- HS Diploma required.
- 2 years of college required (or 3+ years’ experience in Healthcare Revenue Cycle and Provider Enrollment/Credentialing)
- Minimum 4 years’ experience in Healthcare Revenue Cycle
- Agility in managing multiple priorities with strong organizational and time management skills.
- High level analytical skills pertaining to Revenue Cycle Services in a medical billing environment.
- Experience working with a variety of revenue cycle reports to identify potential issues and trends with payments and/or denials.
- At least 1 year of leadership or management experience.
- Knowledge of Payor Credentialing processes, both Par and Non-Par.
- Knowledge and understanding of Taxonomy codes and how they impact claims.
- Knowledge of CMS Regulations and guidelines.
- Thorough understanding of Explanation of Benefits
- Proficient in Microsoft Office applications including Word and Excel.
- Ability to foster a cooperative and respectful work environment.
- Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
- Ability to communicate effectively both orally and in writing.
Preferred Skills and Qualifications:
- Experience working with National Provider Identifier database and process.
- Experience working with Medicare, Medicaid, or any Commercial payor.
- Experience working Credentialing/Provider Enrollment denials helpful.
- Centricity/IDX, Athena or other similar medical billing system preferred.
SCP Health and its affiliated companies (collectively, “SCP Health”) require applicants for specific positions, such as those onsite at a client company/healthcare facility or affiliate to be vaccinated against COVID-19 as a condition of employment, except where prohibited by state or local law. To demonstrate compliance with SCP Health’s vaccination policy, proof of COVID-19 vaccination status will be requested upon a conditional offer of employment for onsite positions at a client company/healthcare facility. SCP health will consider religious and/or medical/disability accommodation and other legally required exemption request as required by applicable law.
Join our social circle:
SCP Health is an Equal Opportunity Employer.