Provider Enrollment Specialist
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POST DATE 8/12/2016
END DATE 10/13/2016
The Provider Enrollment Specialist is a full-time position with primary responsibility for
establishing, maintaining, and constantly reviewing the accuracy of Medicare, Medicaid, CSHCN,
Texas Health Steps, and Railroad Medicare provider billing numbers for providers. This position
will also be responsible for the observation of provider commercial payer enrollment and
maintenance of medical practice management system master files serving provider's practice.
Establishes, maintains, and constantly reviews the accuracy of Medicare, Medicaid,
CSHCN, Texas Health Steps, and Railroad Medicare provider billing numbers for
providers. Ensures that the numbers are (a) correct, (b) attached to the appropriate
provider address, (c) grouped in the appropriate provider groups, (d) communicated to
the appropriate CPG staff for billing and collection purposes, and updated in caseswhere a provider either moves locations, changes billing organizations or leaves. employment/agreement. Maintains observation of provider commercial enrollment.Completes this process for both new and existing providers.
Develops and maintains extraordinary expertise on CPG Medical Practice Management
(MPM) system and Provider Profile Database. Responsible for MPM Master File and
provider database maintenance which will predominantly include completeness and
accuracy of data to ensure clean claim submissions as it pertains to provider billing
numbers. Responsible for monitoring and correcting/clearing all enrollment related
claim issues in MPM system. Maintains documentation of any and all updates and
changes to these files, ensuring the integrity of data by following established CPG
Routinely communicates with both CPG Revenue Cycle, CPG outside billing agents, Ark-
La-TX Health Network, and CPG Managed Care Department to scan for billing and
collection issues related to provider numbers. Confirms accuracy of issues and then
initiate's corrective action to ensure proper flow of billing and collection information to
third party payers. Documents all interaction with parties outside CPG in order to track
the efficiency and effectiveness of contact, date, content of interaction, commitment by
outside party or action and by what date, and then confirmation that such action was
taken and taken correctly.
Serves as a resource to staff to problem solve and answer questions regarding programs
and procedures. In this capacity, establishes excellent customer service skill set.
Perform other related work duties as required.
* High School diploma or equivalent required.
* Requires minimum of five years' experience within the medical practice management
field with emphasis on billing and collection processes.
* Proficiency with Microsoft (Word, Excel, Access, Outlook) applications required.
* Knowledge of physician billing specific to Medicare and Medicaid plans required.
* Knowledge of Medicare, Medicaid and other managed care plan enrollment processes
* Career accomplishments must demonstrate a capacity to work continuously at a highly
detailed level and the ability to meticulously follow-up on and document work
* Candidate must demonstrate a high level of desire for completeness, accuracy and
C. Licenses, Registrations, or Certifications
* None required