SUMMARY: The Provider Enrollment Specialist is responsible for completing, submitting, and tracking applications for Out of State Medicaid provider enrollment.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Complete and submit applications for provider Medicaid Enrollment through CBMS
- Gather and secure all required credentials necessary to submit a qualified provider application in any state
- Calls Medicaid to follow up on application/enrollment status.
- Maintains provider enrollment database for assigned clients ensuring information is up to date and moving through the process efficiently.
- Document CBMS, Company and hospital database with action that was taken on the account/application in a timely manner
- Explain program eligibility requirements to applicants, including all rules and regulations, his/her rights and responsibilities, available benefit dates, reasons for approval or denial, and the right to appeal
- Review cases when necessary for continuing eligibility and taking the necessary action in response to changes
- Maintain knowledge of all State Medicaid and Child Health Plus policy information/guidelines
- Follows current HIPPA guidelines
- Office environment with some exposure to external environment, temperature changes, uneven walking services.
- Talking: Frequently conveying detailed or important instructions or ideas accurately, clearly, or quickly.
- Hearing: Able to hear average or normal conversations and receive ordinary information.
- Repetitive motion: Frequent and regular use of the wrists, hands, and fingers to make small movements such as typing or picking up small objects. Normal fine and gross motor control of fingers and hands.
- Seeing: Visual acuteness necessary for the proper evaluation of or to prepare, inspect documents or other materials. Ability to accurately view computer monitors.
- Physical: Frequent sitting, standing and walking. Occasional lifting up to 25 lbs, pushing and pulling up to 45 lbs. Occasional kneeling, stooping, and bending at the waist.
POSITION QUALIFICATIONS AND REQUIREMENTS:
- 3-5 years of experience coordinating provider enrollment activities, specifically Out of State Medicaid provider enrollment for individuals, hospitals, clinics, and medical groups in multiple states.
- Experience with state benefit management systems (CBMS)
Knowledge, Skills, Abilities and Competencies:
- Direct Out of State Medicaid enrollment experience through state, hospital, or 3rd party vendors
- Ability to capture heavy documentation requirements quickly and accurately in both the company and hospital computer systems while maintaining a 95% accuracy rate
- Ability to be successful in a constantly changing regulatory environment
- Knowledge of all state Medicaid and Child Health Plus policy information/guidelines
- MS Office proficiency
- Strong typing and documentation skills
- Exemplary customer service
- Strong written and verbal communication skills
- Strong time management and organization skill