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Provider Enrollment Specialist

Job ID: 43212
Location: Morrisville, NC
Facility/Division: Shared Services
Status: Full Time
Shift: Day Job

Did you know UNC Health has Ranked #2 Most Trusted Healthcare Brand in the U.S.? The UNC Health brand was ranked as the #4 healthcare brand in the United States overall and the #2 most trusted healthcare brand, just after Johns Hopkins and before Mass General. Join our One-Great-Team!

Job Description

Description

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.

Summary:
The System Provider Enrollment Specialist is responsible for the coordination and tracking process of managed care enrollment.


Responsibilities:
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.


Other Information

Other information:
Education Requirements:
● High School diploma or GED
Licensure/Certification Requirements:
● 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.


Job Details

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


This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Heath Care System. This is not a State employed position. 

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Health Care System, in a department that provides shared services to operations across UNC Health Care. This is not a State employed position.
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Diversity Statement

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.

Equal Employment Opportunity

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Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.

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