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Job ID: 27003
Location: Morrisville, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job
Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.
The System Provider Enrollment Specialist is responsible for the coordination and tracking process of managed care enrollment.
1. Individual Provider and Group Enrollment - Responsible for application management, completion and submission of a variety of forms and supporting documentation that allows the health system and individual providers to participate in Medicare and Medicaid plans. Maintains thorough knowledge and understanding of the various plans and how to organize and submit the supporting documentation required for each enrollment process. Follows an efficient process to ensure an accurate and efficient enrollment.
2. Manages Provider SER Table – Manages the health system’s Provider databases and uses judgment, internal guidelines, and CMS and HIPAA regulations to determine the way in which providers are added and maintained in these data bases.
3. Monitors, researches and resolves suspended and denied charges - Monitors and resolves charges which are suspended due to missing provider data, and/or have denied due to lack of pertinent provider data. Maintains thorough knowledge of the UNC Healthcare billing system, UNC Healthcare GE system, carrier rules, clinical department guidelines, and HIPAA regulations. Identifies the cause of the suspended or denied charges and determines the appropriate steps required to resolve them.
4. Policy Analysis, Communication and Advocacy - Interprets, explains, and follows the regulatory guidelines of government payer plans and keeps abreast of constantly changing payer policies, systems, and processes. Communicates clearly, professionally, and concisely with a diverse group of stakeholders across the health care system to ensure all necessary steps are taken to remain compliant with changes. Establishes and maintains on-going relationships with internal and external stakeholders to ensure effective participation status in payer programs.
5. Collaboration – Collaborates with the clinical departments, UNC Physicians Revenue Cycle Management contacts, Office of Medical Staff Services at UNC hospitals and other affiliate entities to obtain and validate pertinent provider data.
● High School diploma or GED
● No licensure or certification required.
Professional Experience Requirements:
● Five (5) years of experience relating to healthcare, insurance or customer service.
Knowledge/Skills/and Abilities Requirements:
● Ability to work well in a team environment.
Legal Employer: NCHEALTH
Entity: Shared Services
Organization Unit: Provider Enrollment
Work Type: Full Time
Standard Hours Per Week: 40.00
Work Schedule: Day Job
Location of Job: US:NC:Morrisville
Exempt From Overtime: Exempt: No
The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.
UNC Health is an equal opportunity employer. As such, UNC Health offers equal employment opportunities to applicants and employees without regard to race, color, religion, sex, national origin, age, genetic information, disability, sexual orientation, gender identity or political affiliation.