FPA Provider Enrollment Analyst I - Department of Medicine

The Provider Enrollment Analyst (I) is responsible for coordinating the provider enrollment and payer credentialing efforts for contracted FPA providers with Medicare and Medicaid. This individual manages all open provider enrollment tasks/ issues to ensure that providers are reimbursed for services provided and billed, and performs data analysis and special projects as assigned.

Responsibilities

• Enrolls and terminates providers with CMS and other government programs by completing 855 series forms, gathers credentials and associated documentation required for enrollment and process enrollment forms.
• Tracks status of "in process" enrollment forms until final approval received.
• Files provider ID numbers once assigned by governing agencies and performs system updates as appropriate.
• Responsible for the initial setup of new groups and providers for 837P and 835P EDI transactions as well as EFT.
• Monitors TES edits, BAR edits, eCommerce edits, and payer denials for issues related to enrollment, and follow-up on claims until resolved.
• Participates in CBO rebilling efforts due to provider enrollment issues.
• Communicates with providers and other departments to escalate issues, share information and promote the process of obtaining documentation required for enrollment.
• Assists department administrators and providers in performing online PECOS enrollment.
• Assists in the Revalidation letter process, downloading list from CMS, obtaining comparison reports from the Medicare Provider Enrollment Database and scheduling providers for online re-enrollment.
• Utilizes the reports within the Medicare Provider Database to monitor updates, promptly complete work orders and identify work to be completed.
• May assist in special projects, generates metrics, and provides reconciliations, research, and analyses as directed by Management.
• Assists management with Meaningful Use and PQRI tracking and reporting.
• Supports activities related to internal and external audits of providers and/or departments.
• Responds to inquiries and provide information as requested.
• Performs other related duties as assigned.

Qualifications

• Bachelors degree strongly preferred, or equivalent years of Provider/Facility Enrollment or credentialing experience and Associates degree
• Medical Group and Health Plan knowledge preferred.
• Two years minimum of healthcare experience including Medicare or Medicaid Provider or Facility Enrollment or Credentialing experience required, including one year of revenue cycle-specific as well as direct customer service.