Provider Enrollment Claims Specialist

Description

At SCP Health, what you do matters.

As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness.

With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.

Why you will love working here :

• Strong track record of providing excellent work / life balance
• Comprehensive benefits package and competitive compensation
• Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect

What you’ll be doing :

The Provider Enrollment Claims Specialist directly impacts the financial stability of the Company because he / she is the SCP Health representative who researches and resolves the provider enrollment claim denials with Government and Commercial Payors.

Working in collaboration with the Provider Enrollment Team, the Provider Enrollment Claims Specialist, using his / her knowledge of SCP Health policies in conjunction with insurance carrier billing and enrollment requirements works to correct issues that caused claims to deny and rebill corrected claims to receive payment for our providers’ services.

• Serve as the primary contact for Provider Enrollment claim denials with payors, SCP Medical Collections, Revenue Integrity, Systems, and Managed Care departments.
• Review Provider Enrollment denials by assigned payors daily.
• Contact payors to get clear understanding of denial and changes needed to receive payment.
• Prepare appeals, when necessary, when claim denials are payor errors.
• Document all correspondence with payors in the System.
• Provide regular feedback to Manager based on research and calls made to payors
• Monitor changes to payor requirements through payor websites, bulletins, emails, etc and communicate any changes to Manager to ensure changes are made wherever applicable.
• Maintain production requirements determined by Manager.
• Collaborate with the Enrollment team to ensure changes are made when provider enrollment errors occur.

What we are looking for :

• Minimum 3 years’ experience in Healthcare Revenue Cycle
• Knowledge of Payor Credentialing processes, both Par and Non-Par.
• Knowledge and understanding of Taxonomy codes.
• Knowledge of CMS Regulations and guidelines.
• Thorough understanding of Explanation of Benefits
• Agility in managing multiple priorities with strong organizational and time management skills.
• Proficient in Microsoft Office applications including Word and Excel.
• Ability to foster a cooperative and respectful work environment.
• Strong interpersonal and communication skills and the ability to work effectively with a wide range of constituencies in a diverse community.
• Ability to communicate effectively both orally and in writing.
• HS Diploma required.
• 2 years of college preferred. Degree in Healthcare Administration or Business Administration
• Experience working with National Provider Identifier database and process, preferred.
• Experience working with Medicare, Medicaid or any Commercial payor, preferred.
• Experience working Credentialing / Provider Enrollment denials helpful, preferred.
• Centricity / IDX, Athena or other similar medical billing system preferred, preferred.

To learn more about SCP Health, please visit :

Join our social circle :

SCP Health is an Equal Opportunity Employer.

INDJV

LI-SC1