PROVIDER ENROLLMENT SPECIALIST

PROVIDER ENROLLMENT SPECIALIST

Posting Number: SRGV5574
Number of Vacancies: 1
Location: Harlingen, Texas
Department: School of Medicine / Clinical Affairs
FLSA: Non-Exempt

Scope of Job:
Coordinate, monitor and maintain the provider enrollment and re-enrollment processes in a timely and compliant manner with all government and commercial payors.

Description of Duties:
• Facilitates all aspects of provider enrollment, including initial enrollment, re-enrollment, and monitoring of all providers to ensure proper and timely billing and collections.
• Prepares enrollment applications for all health plans including Medicare and Medicaid.
• Maintains timelines on enrollment processes and address and/or escalate any delays.
• Ensures that all pending enrollments are reviewed, obtained and managed according to the rules and policies of the department.
• Provides monthly notification of new providers, resignations and changes in provider status such as practice locations and panel status to contracted plans.
• Follows up with necessary contacts, including providers and managed care organizations, to resolve enrollment application issues and deficiencies.
• Assists with resolution of provider related denials to ensure appeal procedures are followed to result in proper reimbursement.
• Assists with problem identification and timely resolution of payor related issues.
• Responds to internal and external inquiries on routine enrollment and contract matters, as appropriate.
• Performs detailed follow-up activities on assigned accounts according to procedures.
• Maintains confidentiality of all provider enrollment business/work and medical staff information.
• Participates in special projects/assignments.
• Performs other duties as assigned.

Supervision Received:
General supervision from assigned supervisor.

Supervision Given:
Direct supervision of assigned staff.

Required Education:
Associates degree in Business Administration or closely related field.

Preferred Education:
N/A

Licenses/Certifications:
None.

Required Experience:
• Three (3) years of financial, credentialing, billing or related experience in a healthcare organization, or
• Five (5) years of the required experience with a High School Diploma.

Preferred Experience:
N/A

Equipment:
Use of standard office equipment.

Working Conditions:
Needs to be able to successfully perform all required duties. Office Environment; some travel to clinic sites to obtain enrollment documentation and weekend work may be required.

Other:
Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

Physical Capabilities: N/A
Employment Category: Full-Time
Minimum Salary: Commensurate with Experience
Posted Salary: Commensurate with Experience
Position Available Date: 01/18/2022
Grant Funded Position: No
If Yes, Provide Grant Expiration Date:

EEO Statement:
It is the policy of The University of Texas Rio Grande Valley to promote and ensure equal employment opportunities for all individuals without regard to race, color, national origin, sex, age, religion, disability, sexual orientation, gender identity or expression, genetic information or protected veteran status. In accordance with the requirements of Title VII of the civil rights act of 1964, the title IX of the Education Amendments of 1972, Section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act of 1990, as amended, our University is committed to comply with all government requirements and ensures non-discrimination in its education programs and activities, including employment. We encourage women, minorities and differently abled persons to apply for employment positions of interest.

Special Instructions to Applicants:
Dear Applicant, Human Resources will not be held responsible for redacting any confidential information from the documents you attach with your application. The confidential information includes the following: *Date of Birth *Social Security Number *Gender *Ethnicity/Race Please make sure that you omit this information prior to submission. We are advising that Human Resources will be forwarding your application to the department as per your submission. If you have any questions, please visit our Careers site at https://careers.utrgv.edu for detailed contact information.

Additional Information:
UTRGV is a distributed location institution and working location is subject to change based on need.

All UTRGV employees are required to have a criminal background check (CBC). Incomplete applications will not be considered.

Substitutions to the above requirements must have prior approval from the Chief Human Resources Officer.

To apply, visit https://careers.utrgv.edu/postings/32104 jeid-4b25f99c3583c3448741703eae8e3cb6