Payer Activation Specialist

13257 Enterprise Corporate - Managed Health Clinical insights & Operations: Credentialing & Enrollment

Full time

Yes

40

• Will work Monday-Friday with hours between 6-4:30 CST.

• Remote preference for candidates from Illinois or Wisconsin

• Fully Remote Role from these states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY.

• Due to complex requirements, remote work is NOT permitted for short or long periods in: CA, CO, CT, HI, MA, MD, MN, NJ, NY, OR, RI, VT, WA and working Internationally (this includes working while on vacation).

• No relocation, No Sponsorship or transfer of visa for this position now or in the future.

Pay Range

$25.30 - $37.95

Major Responsibilities:

• Coordinates all application processes (application completion, provider communication, Epic provider set-up, etc.) regarding enrollments for Medicare, Railroad Medicare, Tricare, and Medicaid for professional providers and communicates all updates to appropriate areas.
• Responsible for maintaining knowledge of enrollment rules/forms/processes for National Provider Identifier (NPI), Medicare, Railroad Medicare, Tricare and Medicaid (including other state programs) for all provider types.
• Responsible for maintaining all expiration dates for all providers enrolled. Maintains enrollment and re-validation process. Maintains providers folders/files containing provider enrollment documents, signatures and forms while maintaining strict confidentiality.
• Collaborates with providers to apply for an NPI and perform updates/corrections on the National Plan and Provider Enumeration System (NPPES).
• Plans key communication with clinic operational leadership, provider affairs, managed care and credentialed verification team to ensure there are no lapses in provider enrollment that would result in loss of revenue.
• Serves as an expert to the hospital-based clinics, medical groups sites, revenue-producing hospital departments, third party payers, and other Revenue Cycle teams regarding enrollments and enrollment-related issues.
• Responsible for activating and maintaining all provider enrollment tables within Epic to ensure claims are released to the payers only once provider credentialing/enrollment finalized. Coordinates the resolution of claim edits related to NPI, CLIAs, tax IDs, and provider enrollment table.
• Acts as a liaison between clinic operational leadership and Advocate Physician Partners (APP) and the Center for Practitioner Information (CPI).
• Coordinates the resolution of denials related to enrollment issues. Collaborates with Advocate Physician Partners (APP) and the Center for Practitioner Information (CPI) on the resolution of denials related to non-credentialed providers. These denials occur from breakdown of communication of provider information between insurance carrier and Advocate Health Care.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• High School Graduate.

Experience Required:

• Typically requires 5 years of experience in working with an automated patient accounting system.

Knowledge, Skills & Abilities Required:

• Strong understanding of governmental and insurance carrier credentialing process for providers and facilities.
• Knowledge of current Medicare/Medicaid payor guidelines and requirements.
• Strong analytical, organizational, and communication skills essential.
• Must have ability to function in a multi-disciplinary environment.

Preferred:

• PECOS experience
• MD-Staff experience
• Experience working with IL and WI Medicare and Medicaid websites

Physical Requirements and Working Conditions:

• Must be able to sit for extended periods of time.
• Position requires travel; therefore, incumbent may be exposed to road and weather conditions.
• Generally exposed to a normal office environment.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training

• Premium pay such as shift, on call, and more based on a teammate's job

• Incentive pay for select positions

• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs

• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability

• Flexible Spending Accounts for eligible health care and dependent care expenses

• Family benefits such as adoption assistance and paid parental leave

• Defined contribution retirement plans with employer match and other financial wellness programs

• Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.