Oversees the production capability of the provider enrollment department
- Plan and control effective practices to ensure that all providers are enrolled accurately with applicable payers in a timely manner
- Implement and monitor compliance with all revenue cycle and departmental specific policies and procedures, ensuring maximum effectiveness
- Respond to third-party inquiries/complaints and determine and initiate appropriate action
- Ensure staff is productive by tracking productivity measures
Actively participate in all functions relating to the administrative work in coordinating the enrollment and re-enrollment process of providers with the Alabama Department of Mental Health, Medicaid, Medicare, and other third-party payers
- Ensure accurate enrollment applications for new providers are completed in a timely manner.
- Maintain accurate information with regards to the re-enrollment standards for all payers.
- Ensure re-enrollment applications are submitted in a timely manner to ensure that providers are up to date with their re-enrollment status.
- Follow up with the contractual insurance carriers regarding provider/facility enrollment/termination/relocation status.
- Enroll all providers in CAQH and provide re-attestations as needed
Maintains the Provider Enrollment Database
- Issues monthly reports from the the database to ensure proper communication regarding provider status related to enrollment
- Provides additional status reports and updates as needed.
- Updates the appropriate provider enrollment matrix.
- Tracks progress of outstanding applications and inform the appropriate parties of in-network effective
Communicates and Coordinates efforts with outside billing companies and the AltaPointe billing department to ensure billing denials due to enrollment issues are addressed in a timely manner.
- Communicates with internal management, providers, and departments in regards to the enrollment process
- Proactively communicates with Human Resources in regards to the needs/requirements of the enrollment department as it relates to provider
- Works closely with providers to obtain the necessary
- Assists providers in obtaining/updating an NPI number.
Coordinate and communicate with the billing department
- Collaborates with the billing department to resolve any provider based denial issues related to the enrollment process.
- Communicates with appropriate billing staff regarding the status of a provider’s enrollment with individual payers. Any significant delays must be reported to management
- Assists with the maintenance of the Practitioner Enrollment forms in Avatar in a timely manner.
Courteous and respectful towards consumers, visitors, and co-workers
- Treat consumers with care, dignity, and compassion
- Respect consumers’ privacy and confidentiality
- Is pleasant and cooperative with others
- Assist consumers and visitors as needed
- Personal values don’t inhibit the ability to relate and care for others
- Is sensitive to the consumer’s needs, expectations, and individual differences
- Is gentle and calm with consumers, families, and others as appropriate
Administrative and Other Related Duties as assigned:
- Actively participate in Performance Improvement activities
- Actively participate in AHS committees as requested
- Complete assigned tasks in a timely manner
- Follow AHS policies and procedures
- Receive and respond to inquiries of billing matters promptly and courteously.
- Assist with performance of duties of other staff in periods of absence.
- Perform other duties as assigned.