Provider Enrollment Specialist – Office Specialist, UMP

• Conduct complex, specialized duties to track, enter and review correspondence from medical stakeholders, partners and the public.
• Review rejected claims from medical providers and Medicare crossover rejections.
• Respond to inquiries from providers requesting information/application on becoming a provider in the Illinois Medical Assistance Program.

• Requires knowledge, skill and mental development equivalent to two (2) years of secretarial/business college and one (1) year of office experience, or completion of high school and three (3) years office experience, or three (3) years of independent business experience
• Qualifying state employees, in the employee Upward Mobility Program, may complete combinations of specific proficiency tests and training programs leading to a certificate of proficiency in lieu of the stated requirements for this classification

Demonstrates expertise in managing correspondence and inquiries from medical stakeholders while ensuring compliance with the Illinois Medical Assistance Program. Proficient in reviewing and processing medical claims and rejections with attention to detail and accuracy.

• Medical Claims Review
• Correspondence Management
• Office Experience
• Provider Inquiry Response
• Illinois Medical Assistance Program Knowledge

• Claims Processing
• Data Entry
• Record Keeping
• Office Administration
• Business Communication

• Attention to Detail
• Problem Solving
• Interpersonal Communication

• Certificate of Proficiency

• Medical Stakeholders
• Medicare
• Provider Enrollment
• Rejection Review
• Office Procedures