Provider Enrollment Specialist

Nemours is seeking a Provider Enrollment Specialist in Jacksonville, FL.

Primary Function:

Individuals in this role interact with Nemours internal and external stakeholders to perform Enrollment and Re-Enrollment of our organization and its healthcare professionals.

This individual will:

Possess accuracy and attention to detail in administrative and technical duties.

Follow the enrollment processes for all managed care networks and government payors that the organization is contracted with, or has an agreement with, for the reimbursement of services.

Have continuous contact with internal and external customers, including physicians and other healthcare providers, administrators, support staff and network representatives.

This individual is responsible for communicating provider participation information to stated internal and external customers through established processes to allow for appropriate patient scheduling and reimbursement for services rendered.
Essential Functions:

Accurately complete the enrollment/ re-enrollment processes as outlined by each network/area for all appropriate healthcare providers.

These will be identified through department policies, network reimbursement and delegated contracts to ensure timely and continued provider network participation.

Maintain detailed provider enrollment files in electronic format, including electronically received documents and scanned hardcopy documents, while appropriately following each stage of the enrollment/re-enrollment process thoroughly and respecting Nemours process for PHI.

Accurately maintain all internal systems with the appropriate provider and network participation information.

Systems including, but not limited to, ECHO, Excel, PET Tracker, iGuide, Qliksense, the NPL tracker, internet, Outlook, and word processing.

Performs follow up with health plans and their representatives to expedite participation approval by each health plan.

Develop and maintain good working relationships with Nemours providers and support staff to obtain necessary and timely information and to facilitate the provider enrollment/re-enrollment process.

Develop and maintain relationships with Network Representatives to facilitate the provider enrollment/re-enrollment processes and maintain accurate data in the plan directories.

Responsible for sending enrollment applications to providers, as appropriate, to maintain signatures and demographic information.

Work collaboratively with fellow team members to create, evaluate and maintain department workflows, processes, policies, and systems.

Additionally, each team member is expected to cross train on plan requirements to assist one (or more) other team member(s) in completing assigned duties.

Will assist with special priority projects and other miscellaneous duties and responsibilities, as assigned by employee's supervisor or department leadership.
Requirements:

Associate Degree Required

Equivalent work experie...