Provider Enrollment Coordinator

Our Client, a Retail Pharmacy company, is looking for a Provider Enrollment Coordinator for their Remote location.

• The Enrollment Coordinators play a critical role in working with our new member clients to determine eligibility and perform various enrollment activities.
• Enrollment Coordinators interface with both individual plan members and employer group and requires a strong focus around accurate and timely customer support to ensure client enrollment and retention.
• The Enrollment Coordinator III reports directly to the Enrollment Supervisor, also functioning as SME (Subject Matter Expert) in the functions, processes, and eligibility procedures as they relate to Medicare Part D enrollment and CMS (Center for Medicare/Medicaid Services) Standards.
• The Coordinator III will work directly with other coordinators to ensure quality of work delivered, performance/productivity benchmarks are met, and all compliance related issues are properly addressed, trained and coached on a consistent basis.
• Ensuring timely and accurate processing of Payer Enrollment applications (Initial and Revalidations) for Clinics and Providers.
• Provide quality control for timely and accurate individual enrollment applications submitted for Medicare and Medicaid programs.
• Resolve claims issues for individual payers in corporate billing system.
• Researching, completing and maintaining compliance with individual Government payers through credentialing, re-credentialing and audit processes and procedures.
• Contact Providers when Revalidation notices are received in order to obtain signature pages and validate current general information. Interact with the field (SPM and CPMs) in regards to escalation notices.
• The Payer Enrollment Coordinator will be responsible for identifying and quantifying trends/issues and then effectively communicating them to the appropriate members of the management team along with what the potential impact could be.
• Minimize denials and deactivation of government applications where applicable to reduce key metrics including DSO, cost to collect, percent of aged claims, and Bad Debt.
• Update Credentialing and Billing systems with Provider information upon inquiry or receipt from Government /Commercial payers.
• Maintain existing contracts:
• Complete, maintain, and monitor applications for Initial enrollment and Revalidation with Government Payers and some Commercial for Clinics and Providers in order to ensure active participation in Medicare and Medicaid programs.
• Maintain working knowledge of statutory regulations for Medicare, Medicaid, and Commercial enrollment and claims submission requirements.
• Ensure timely and accurate Group/Provider enrollment applications are submitted for Medicare and Medicaid programs.
• Minimize deactivation of government applications by following quality control procedures.
• Contact Providers when Revalidation notices are received in order to obtain signature pages and validate current general information.
• Receive escalated claim issues from other internal departments and coordinate contact with payer to develop solutions and when brought to resolution; communicate to others internally as appropriate. 75%

• Update Credentialing and Billing systems with Provider information upon inquiry or receipt from payers.
• Create content for state summary, policy and procedures, maintain existing training modules.
• Research potential issues, develop solutions and bring to resolution.
• Send communication/updates to the field as needed. 10%
• Financial Analysis:
• Research and analyze trends ( i.e. claims, providers, clinics) in order to make recommendations for process improvements and system efficiencies
• Keep an issue log with all provider payer issues for your states each week.
• Work with SPM and CPMs to ensure that all providers are enrolled in the correct locations, report on all discrepancies and plan for process improvements.
• Review all Claims on manager hold/hold i.e. trends, errors, enrollment in new locations, correct ins.
• Pkg. review non-billable services, etc.
• 9%

• Ensure all enrollments and specific data is maintained timely and accurately in the tracking system so all information can be easily referenced.
• Identify and improve tracking system for efficiency.
• 5% for mid-level and senior executives

• High school diploma or GED required, Bachelors Degree in Business Administration, Marketing, Finance or similar field preferred and have 2+ years of relevant work experience.
• 2 years of overall provider enrollment related experience of Center for Medicare/Medicaid Services (CMS) guidelines for Medicare Part B enrollment processes or previous work experience in regulatory environment

• Health Benefits
• Referral Program
• Excellent growth and advancement opportunities

As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of…