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Assists Provider Enrollment Specialist, Sr. Provider Enrollment Specialist and Supervisor in a team effort on projects, such as new start-ups, change in business (i.e. tax ID numbers and entities) as required by carrier, or when directed by the Supervisor.
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The Enrollment Coordinator must ensure that all assignments are completed accurately and in a timely manner in accordance with NYSDOH Medicaid guidelines, MLTC provider regulations, and agency policies and procedures.
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Experience working with managed care claims, third-party liability, Medicaid waiver programs, and provider enrollment; Knowledge and expertise in managed care claims, third-party liability, Medicaid waiver programs, and/or provider enrollment.
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The Credentialing and Provider Enrollment Coordinator executes these activities in compliance with the standards of The Joint Commission, Centers for Medicare and Medicaid Services, and the Bylaws, Policies and Rules and Regulations of CBHA Provider Staff.
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This position is part of DMPS Office of Communication Advocacy, Resolution and Enrollment's (OCARE) specialized units dedicated to serving the Office of the Client Advocate (OCA) Community Partners, Special Accommodations, Justice Enrollment, and/or Provider Services by resolving problems and responding to inquiries and concerns from high level sources within AHCCCS, AHCCCS providers, state and local government entities, members, general public, and community partner organizations.
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Some tools may include but are not limited to Authorization Guidelines, Insurance Guidelines, Fee Schedules, NPI (National Provider Identifier), PECOS (the Medicare Provider Enrollment, Chain, and Ownership System) and "How-To" documents.
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At AdaptHealth we offer full-service home medical equipment products and services to empower patients to live their best lives - out of the hospital and in their homes. AdaptHealth is an equal opportunity employer and does not unlawfully discriminate against employees or applicants for employment on the basis of an individual's race, color, religion, creed, sex, national origin, age, disability, marital status, veteran status, sexual orientation, gender identity, genetic information, or any other status protected by applicable law.
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AdaptHealth Opportunity - Apply Today! Obtain pre-authorization if required by an insurance carrier and process physician orders to insurance carriers for approval and authorization when required. Answer questions about products and services, retail stores, general service line information and other information as necessary based on customer call needs.
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The Customer Service Specialists works in a fast-paced environment answering inbound calls and making outbound calls. General knowledge of Medicare, Medicaid, and Commercial health plan methodologies and documentation requirements preferred.
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Complete insurance verification to determine patient's eligibility, coverage, co-insurances, and deductibles. Actively listens to patients and handle stressful situations with compassion and empathy. Customer Service Specialist.
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Must be able to navigate through multiple online EMR systems to obtain applicable documentation. Enter and review all pertinent information in EMR system including authorizations and expiration dates. One (1) year work related experience in health care administrative, financial, or insurance customer services, claims, billing, call center or management regardless of industry.
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Process orders, route calls to appropriate resource, and follow up on customer calls where necessary. Meet quality assurance requirements and other key performance metrics. Exact job experience is considered any of the above tasks in a Medicare certified.
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Verify insurance carriers are listed in the company's database system, if not request the new carrier is entered. Customer Service Specialists are responsible for learning and understanding the entire front-end process to ensure successful service for our patients.
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This is an in-person role based in a hospital setting with direct patient contact. Maybe responsible for obtaining, analyze, and verify the accuracy of information received from referrals, create orders, and or schedule the patient to receive equipment as ordered by their doctor.
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This policy applies to all terms, conditions, and privileges of employment, including recruitment, hiring, placement, compensation, promotion, discipline, and termination. Analytical and problem-solving skills with attention to detail.
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provider enrollment jobs
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