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Provider Enrollment Representative (Credentialing and Billing experience needed!
Arlington, VA
Job Description
Job Summary
- Performs all activities related to Provider Enrollment with Government payers to include timely and accurate enrollment of all new providers into existing government contracts, enrollment of existing providers into new contracts and maintaining existing providers in current contracts (Medicare and Medicaid revalidation). Maintains accurate and complete information in the IDX Billing Provider and the MPBS Provider Enrollment Database. Acts as liaison with assigned clinical departments to ensure optimal flow of information between the providers and MPBS. Ensures compliance of MPBS-directed activities related to delegated and centralized credentialing requirements, including timely and accurate enrollment of all new providers into existing third party contracts, enrollment of existing providers into new contracts, maintenance of existing providers in current contracts. Reviews and confirms accurate maintenance and complete information in the IDX Billing Provider Dictionary and the MPBS Provider Enrollment Database.
Minimum Qualifications
- Education/Training
- High School graduation or equivalent; Associate’s Degree preferred. Consideration will be given to an appropriate combination of education/training and experience.
- Experience
- 3 years of medical billing experience and provider enrollment and/or credentialing in the health care field is required. GE IDX and ETM experience is strongly preferred.
- License/Certification/Registration
- No special certification, registration or license required.
- Knowledge, Skills & Abilities
- Outstanding critical thinking and analytical skills, End-user computer skills with Microsoft Office package, Proficiency with Microsoft Access database software. Excellent multi-tasking skills. Must possess excellent communication skills, and be able to interact with professional and administrative personnel. Ability to communicate effectively with all levels of MedStar associates. Ability to work in a high-pressured environment with time constraints while maintaining a professional demeanor. Must be able to remain calm and use diplomacy when dealing with stressful situations.
Primary Duties and Responsibilities
- Acts as liaison with clinical departments to ensure optimal flow of information between the providers and MPBS.
- Acts as a Liaison with the Managed Care Team for group and provider enrollment/maintenance for non-government payers.
- Ensures appropriate and accurate maintenance of group enrollment records with Government Payers.
- Ensures appropriate maintenance of a knowledge database of current enrollment guidelines and requirements.
- Ensures that unfavorable payer decisions/enrollment records are corrected and/or appealed in a timely manner.
- Maintains knowledge of contemporary standards and issues in provider enrollment, credentialing, managed care related, and NCQA trends.
- Monitors Accounts Receivable and ensure its resolution when impacted by provider enrollment related occurrences/issues.
- Participates in educational/professional development activities. Exemplifies Guest and Staff Relations standards in all activities in areas of service, resource utilization, high quality outcomes and effective communication and holds staff accountable for conformity with those standards in all activities.
- Performs all activities related to successful enrollment and recertification of MPBS providers.
- Reviews and analyzes billing dictionary records for accuracy.
- Reviews and approves new enrollment records and ensures IDX dictionary updates and reviews and corrects provider related edits in IDX/ETM systems.
- Reviews and responds to provider enrollment related questions/concerns and correspondence in a timely manner.
- Reviews, identifies, corrects, and maintains provider enrollment paper/electronic records as well as provider profiles with payers.
- Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.
- Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings, serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.
- Performs other duties as assigned.
MedStar Health is dedicated to providing the highest quality care for people in Maryland and the Washington, D.C., region, while advancing the practice of medicine through education, innovation and research. Our 30,000 associates and 5,400 affiliated physicians work in a variety of settings across our health system, including 10 hospitals and more than 300 community-based locations, the largest visiting nurse association in the region, and highly respected institutes dedicated to research and innovation. As the medical education and clinical partner of Georgetown University for more than 20 years, MedStar is dedicated not only to teaching the next generation of doctors, but also to the continuing education and professional development of our whole team. MedStar Health offers diverse opportunities for career advancement and personal fulfillment.
MedStar Health is an Equal Opportunity (EO) Employer and assures equal opportunity for all applicants and employees. We hire people to work in different locations, and we comply with the federal, state and local laws governing each of those locations.
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Work Hours (i.e. shift)
Day Shift
Required Education
High School or Equivalent
Required Experience
3+ years
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