Job Description

RESPONSIBILITIES

The Provider Enrollment Account Manager will accept and be assigned clients to manage.
The Provider Enrollment Account Manager will be responsible for managing the clients assigned to them, being the client's primary point of contact, and delegating and assigning tasks and projects to the offshore team on a daily basis.
The Provider Enrollment Account Manager will delegate projects and tasks to the offshore team and manage turnaround time, and quality of the completed work. Meet with and train offshore staff as needed.
The Provider Enrollment Account Manager will also be responsible for working normal business hours and so they can be available to the offshore team for questions or concerns as well as clients.
The Provider Enrollment Account Manager will mentor, train and coach the offshore team.
The Provider Enrollment Account Manager will manage all phases of provider enrollment, re-enrollment, contracting, fee schedule review and negotiations, and expirable management ensuring the timely and accurate enrollment (and recredentialing) of providers into various payers utilizing the offshore team.
Instruct Offshore team which payer(s) should be contacted when follow up is needed, requesting network participation, and follow up on submitted applications.
The Provider Enrollment Account Manager will coordinate in obtaining necessary data needed for enrollment, contracting, and other related purposes from clients and will provide instructions to Offshore on how to handle all data within the software.
Oversee the completion and submission of provider enrollment applications for all clients.
Obtains required client signatures and forward the appropriate information when received to offshore for the process to be completed.
Communicate with Offshore to process all initial enrollments and re-enrollment applications, including revalidations for Medicare and/or Medicaid as requested by client.
Provide offshore a list of clients and projects that should be followed up on weekly basis
Provide each client a weekly status report and the email and status report should be uploaded into STAT.
Manage CAQH/CAQH re-attestations including expirable which should be performed by offshore.
Maintain the timelines on enrollment/credentialing schedules, communicate with providers and other departments to update as needed, clarify carrier information requirements, and maintain a strict level of confidentiality for all matters pertaining to provider credentials.
Works in all phases of provider enrollment, re-enrollment, contracting, fee schedule review and negotiations, and expirable management ensuring the timely and accurate enrollment (and recredentialing) of providers into various payers (Medicare, Medicaid, and commercial health insurance companies).
Contacting payer(s) by phone, requesting network participation and follow up on submitted applications.
Coordinate's credentialing data needed for enrollment, contracting, and other related purposes.
Completion & Submission of provider enrollment applications.
Works closely with providers to obtain missing documentation.
Obtains required client signatures and follows up with the carriers on documentation submitted on a weekly basis and per company policies.
Processes all initial enrollment and re-enrollment applications, including revalidations for Medicare and/or Medicaid as requested.
Follow-up and Follow-through on all submitted applications.
Expirable management.
CAQH set-up and CAQH re-attestations.
Maintain the timelines on enrollment/credentialing schedules, communicate with providers and other departments to update as needed, clarify carrier information requirements, and maintain a strict level of confidentiality for all matters pertaining to provider credentials.
Provide company feedback to reduce errors and improve processes.
Anticipate customer needs and proactively identify solutions.
Works independently and as a team solve complex problems.
Provide utmost customer service.
Adapt well in a changing environment.
Act as the point of contact and supervisor for all clients assigned.
Performs database and computer functions as required and per company policies - Extensive computer and software experience is a must - it is essential that you are very computer savvy since all work is done remotely.