Provider Enrollment Representative

Experience these exceptional benefits when you join Med-Metrix! 8-Hour Shifts, Fixed Weekends Off Day 1 HMO with 2 of your dependents covered for FREE Group Life Insurance Medical Cash Allowance Rice Allowance Clothing Allowance Holiday Gift Bereavement Assistance Free Lunch Daily Paid Time Off Training and Staff Development Employee Engagement Activities Opportunities for Internal Mobility Job Purpose The Provider Enrollment Representative is responsible for credentialing/enrolling new and established health care providers and maintenance of required information.   Duties and Responsibilities Communicates with providers to explain process and sign applications Collects, updates, maintains necessary provider information and documentation and verifies the information where possible Establishes and maintains data entry in CAQH Prepares provider enrollment applications for all initial applications and re-credentialing in a timely and complete manner Verifies provider and group information with insurance companies (addresses, contracted plans, provider ID numbers, etc.) Coordinates information for enrollment and termination of all providers Handles enrollment with Medicare, Medicaid, commercial insurances Contributes to the departmental process and procedures with a collaborative approach Works department client WQ’s and smart feeds where applicable Maintains provider enrollment mailbox and completes actions and follow up Performs other duties as requested Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards Understand and comply with Information Security and HIPAA policies and procedures at all times  Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties  Qualifications High School graduate or equivalent required Minimum two years of provider enrollment experience Knowledge of Microsoft Office Suite, Outlook, Excel, CAQH Billing knowledge and experience preferred Excellent verbal and written communication skills Strong interpersonal skills, ability to communicate well at all levels of the organization  Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses  High level of integrity and dependability with a strong sense of urgency and results oriented   Excellent written and verbal communication skills required  Gracious and welcoming personality for customer service interaction  Working Conditions Work Set-Up: Onsite Work Schedule: US hours, night shift; must be flexible to accommodate business needs. Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear. Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress. Work Environment: The noise level in the work environment is usually minimal.   Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.