Summary
 

Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines.

Description
 

What You’ll Do:

• May perform any or all of the following in the enrollment of providers: determines the acceptability of provider enrollment applications (which may be used for initial full application, reenrollment, reactivation, change of information); provides in-depth review and verification/validation of provider data; verifies provider data by use of information databases and various organizations/agencies to ensure authenticity; sets up/tests EFT accounts.

• Processes/enters/updates provider data information/applications into appropriate enrollment database used in evaluating/tracking the processing of the application and/or updating of provider directories.

• Provides quality service and communicates effectively with external/internal customers in response to inquiries (correspondence, telephone).

• Obtains information from internal department, providers, government and/or private agencies, etc. to resolve discrepancies/problems.

• Supplies enrollment applications and general information on the enrollment process to interested enrollees.

• Contributes to and participates on special projects related to provider files.

• Assists Technical Support staff with testing system changes related to provider files.

• Assists with process improvements related to Provider Enrollment.

• Assists with provider education and provider services training.

• Work environment: Typical office environment.

• Potential remote opportunity with MAC (Medicare Administrator Contractor) Provider Enrollment experience. If no MAC (Medicare Administrator Contractor) experience, work location will be Columbia, SC, Monday - Friday 8 AM to 5PM.

                   

To Qualify for This Position, You’ll Need:

• Bachelor's degree OR Four (4) years of job-related work experience OR Associate’s Degree and Two (2) years of experience.

• Working knowledge of word processing, spreadsheet, and database software.

• Good judgment skills required.

• Effective customer service and organizational skills required.

• Demonstrated verbal and written communication skills.

• Demonstrated proficiency in spelling, punctuation, and grammar skills.

• Basic business math proficiency required.

• Analytical or critical thinking skills required.

• Ability to handle confidential or sensitive information with discretion.

• Microsoft Office.

We Prefer That You Have:

• Medicare experience in Part A and/or Part B Provider Enrollment or credentialing experience.

• Bachelor’s Degree in Business Administration or Health Administration

• In-depth knowledge of provider certification process, claims processing operations/systems, and pricing methodology and discount programs.