MD Anderson Cancer Center Patient Business Services Provider Enrollment Specialist in Houston, Texas
Purpose: To assist in processing and tracking provider enrollment applications reconcile managed care provider roster accurately and in a timely manner and maintain all Epic/SER/Databases related to provider enrollment/billing.
Scope: Impacts A/R, Customer Service, Insurance Collections, Managed Care, all end-users of the Provider Participation Database (PPD) including Business Centers, Faculty Academic Affairs, Faculty Departments and Faculty members.
Salary Range: Minimum $38,800 - Midpoint $49,500 - Maximum $60,200
Essential functions of the job include, but are not limited to:
Primarily responsible for ensuring that all healthcare professionals responsible for billing (physicians, physician assistants, nurse practitioners, etc.,) are enrolled in all government plans to include Medicare 855i, Medicare 855r (UPIN), Railroad Medicare, Texas Medicaid, Tricare/Champus, Blue Cross/Blue Shield of Texas PAR plan.
Monitor and maintain database or tracking spreadsheet of status on all providers currently in the enrollment process.
Coordinate information regarding provider enrollment, the Medical Staff Office, Managed Care and Credentialing as needed.
Provide assistance and timely feedback regarding missing provider information to clinical departments, Medical Staff Office, Managed Care.
Maintain Epic SER and coordinate with PBS-IS since the information may affect claim logic.
Maintain current information of provider enrollment process for the carriers listed above.
Document all applications and processes.
Work with Billing department to resolve issues with up-front edits regarding deactivated provider numbers.
Process TES (transaction editing system) and Claim edits in Epic work queues. Report outstanding edits due to missing provider numbers to department manager.
Ability to communicate effectively (verbal and written) with managed care and governmental insurance carriers regarding provider enrollment status.
Working knowledge of business applications (Excel, Word, Medical Staff Line System/ECHO, Epic/SER, etc.).
Serve as a Notary for provider enrollment information.
Ability to provide detailed reports regarding the status of current provider billing and managed care enrollment information roster.
Handle routine and timely reporting to payors per DCA and maintain documentation.
Participate in managed care and other PBS operational meetings as instructed.
Prepare, review and distribute payor notifications via provider profiles or rosters regarding additions, deletions, terminations or changes to MDACC's Medical Staff to contracted managed care organizations within 3 business days of notification from the MSO.
Prepare and distribute internal notifications of new providers monthly within 3 business days of CCMS meeting (Function will be replaced by Provider Participation Database).
On a quarterly basis, obtain contracted managed care organization provider rosters specific to the PRS tax identification number and perform manual reviews to ensure that all PRS/MDACC providers are loaded accurately in the payors system. Resolve any discrepancies and document. Update Provider Participation Database as appropriate.
Assist contracted managed care organizations with all inquiries pertaining to provider enrollment.
Prepare clinical faculty notifications regarding managed care credentialing/enrollment issues for review by Managed Care Contract Administrators or Manager of Managed Care Operations and distribute per their approval/instructions.
Serve as liaison between PBS, the Medical Staff Office, Faculty Academic Affairs and Managed Care to ensure that provider enrollment and credentialing processes are efficient and timely.
Provide support within the institution regarding status questions on provider enrollment. Expectation that clinic inquires be responded to within 24 hours and patient accounting inquiries within 48 hours or less.
All development, maintenance, support and implementation responsibilities for PPD. PPD maintenance and support to include the required elements of insurance plan, effective date, mailed to date, participation code, termination code, ID number (billing numbers), and PIN (as per plan guidelines).
Maintain current knowledge about managed care and governmental regulations regarding provider enrollment.
Complete special projects as assigned
Education Required: Associate's degree in Business Administration or related field.
Experience Required: Five years of experience in healthcare, insurance, business or managed care to include one year in provider enrollment, billing or governmental regulations. May substitute required education degree with additional years of equivalent experience on a one to one basis.
Must pass pre-employment skills test as required and administered by Human Resources.
It is the policy of The University of Texas MD Anderson Cancer Center to provide equal employment opportunity without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, disability, protected veteran status, genetic information, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. http://www.mdanderson.org/about-us/legal-and-policy/legal-statements/eeo-affirmative-action.html