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Penn Medicine, University of Pennsylvania Health System · 21 hours ago

Payer Enrollment Specialist

Philadelphia, PA

Full-time

Hybrid

Entry, Mid Level

2+ years exp

Penn Medicine is dedicated to providing high-quality patient care and conducting innovative research. The Payer Enrollment Specialist will be responsible for enrolling practitioners with health plans to ensure billing and reimbursement for services rendered.

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Responsibilities

Works with providers, departments, and Professional Billing Office staff to complete provider enrollment process in a timely and efficient manner in accordance with service standards

Works with health plan staff to ensure their information needs are met and that they provide provider numbers on a timely basis

Completes, submits and follows up on managed care exports and/or government payers (DE/PA/NJ Medicare, PA/NJ Medicaid, Rail Road) or Behavioral Health (Perform Care, Community Care Behavior Health -CCBH) applications sent to the assigned health plans for enrollment into their network

Ensures that provider and practice changes are submitted to the assigned health plans and are accurately processed by the health plans

Performs special projects and/or run reports to support the provider enrollment process for the assigned health plans

Maintains proficiency in utilization of enrollment databases and other systems required for enrollment with assigned health plans (e.g. PECOS, Promise, Navinet, CAQH, Health Plan Portals)

Serves as liaison between the departments/practices and health plans in order to resolve enrollment issues

Analyzes the various Enrollment Reports for assigned plans to ensure that the providers’ enrollments have been completed with the health plans

Researches department/practice complaints and/or independently identifies data errors/inconsistencies and other problem areas with enrollment database and resolves or refers issues to manager as appropriate

Performs duties in accordance with Penn Medicine and entity values, policies, and procedures

Other duties as assigned to support the unit, department, entity, and health system organization

Qualification

Payer enrollmentMedicare/Medicaid knowledgeMicrosoft WordMicrosoft ExcelMicrosoft OutlookDeadline managementCommunication skillsTeamworkConfidentialityProblem-solving

Required

H.S. Diploma/GED is required

2+ years of experience working in payer enrollment and/or in a similar position required, preferably in a health care organization

Ability to use Microsoft Word

Ability to use Microsoft Excel

Ability to use Microsoft Outlook

Must have the ability to maintain information in a confidential manner in accordance with all regulatory requirements

Must be able to work independently, take initiative and persevere in obtaining application documentation while communicating in a professional manner

Must have an understanding of government (Medicare/Medicaid), Managed Care or Behavioral Health plan enrollment policies and procedures

Must be able to work effectively as a member of a team

Must be able to meet deadlines

Must be able to exercise good judgment when escalating issues

Must demonstrate strong communication skills - verbal/written - with providers, internal customers and external contacts

Benefits

Comprehensive compensation and benefits program

Prepaid tuition assistance programs

Company

Penn Medicine, University of Pennsylvania Health System

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Penn Medicine is a world leader in academic medicine, setting the standard for cutting-edge research, compassionate patient care, and the education of future health care professionals.

Founded in 1765

Philadelphia, Pennsylvania, USA

10001+ employees