Transplant Global Billing/Payer Enroll Specialist

If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One!
 

We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South.
 

Manages more complex patient accounts from third party payors and patients associated with the Transplant Unit to maximize cash receipts and minimize receivables while maintain effective customer relations. Facilitates and coordinates the payer enrollment process for submission to managed care insurance companies and other agencies on behalf of Methodist Le Bonheur Healthcare. Establishes the timely and efficient flow of reimbursement for services and compliance of payer credentialing requirements. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

 

Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence.

A Brief Overview
Manages more complex patient accounts from third party payors and patients associated with the Transplant Unit to maximize cash receipts and minimize receivables while maintain effective customer relations. Facilitates and coordinates the payer enrollment process for submission to managed care insurance companies and other agencies on behalf of Methodist Le Bonheur Healthcare. Establishes the timely and efficient flow of reimbursement for services and compliance of payer credentialing requirements. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

What you will do

• Reviews and edits claims for Transplant Global billing. Edits and files electronic and paper hospital claims to third party payers for payment as evidenced through maintaining on a daily basis a minimal to zero volume of claims.
• Identifies and communicates problems regarding claims. Provides customer service by answering inbound phone calls, handling complaints, resolving routine and standard issues. Handles routine and standard patient complaints and refers more complex or difficult complaints to a higher level.
• Reviews, follows up, and collects payment of claims for Global Transplant accounts. Analyzes more complex accounts for collectability purposes.
• Determines global payment and calculates Physician payments. Reviews credit balance accounts and supporting documentation to determine if financial transaction or refund is necessary to resolve.
• Coordinates credentialing and re-credentialing applications on behalf of MLH for submission to managed care companies, out of state Medicaid and other agencies.
• Administers application compliance to obtain licenses and hospital privileges on behalf of new and existing providers.
• Reviews information for completion, initiates information collection, verification, and documentation process per established policies and procedures. Obtains necessary information when needed. Strong understanding of navigating payer websites for documentation requirements, checklists, etc.
• Works with appropriate associates to complete the relevant information on EDI forms for Electronic Funds Transfer (EFT), Electronic Claims submission (837) and Electronic Remittance (835) setup.
• Provides support for Single Letter of Agreement (SLOA) and negotiates appropriate rates for the MLH system-wide facilities for all Out of Network payers or “unique” services considerations.
• Conducts primary source of verification for prospective and current providers. Collects and maintains electronic files of State Licenses, DEA certificates, CLIA, CMS, JACHO and other documents for all MLH entities. Tracks license and certification expirations for all providers to ensure timely renewals. Communicates status of credentials process and approvals/denials with appropriate individuals.
• Manages the support, training and development of Online Services for PFS.
• Performs other job functions as assigned or requested.

Education/Formal Training Requirements

• High School Diploma or Equivalent
• Bachelor's Degree

Work Experience Requirements

• 1-3 years Credentialing

Knowledge, Skills and Abilities

• Proficient in Excel, Word, ability to function in multiple data bases efficiently.
• Strong organization skills, ability to multi-task high volume of files in various statues at the same time.
• Ability to meet deadlines and work in a fast pace setting.
• Ability to function with minimal supervision.
• Ability to communicate effectively with high leve