Provider Enrollment Specialist

Overview

Preference to candidates with ENROLLMENT, CREDENTIALING, and/or BILLING experience.

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

The Provider Enrollment Specialist is responsible for obtaining and coordinating all necessary provider enrollment applications for billing to Medicare, Medicaid and Contracted Insurance Payers. Functionally, these activities are key to the maintenance of the physician group, individual physician records, regulatory, and hospital contract compliance.

Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.

Responsibilities

Essential Functions

• Prepares documents necessary to enroll physicians and non-physician providers with insurance carriers.
• Maintains deletions, additions, and changes to the Physician Enrollment file pertaining to all pertinent information including review of payer membership.
• Handles telephone communications and written correspondence with providers and fiscal intermediaries in an efficient and effective manner that facilitates the Provider Enrollment process.
• Maintains updated information per Insurance carrier requirements through contact with the carriers and by reviewing bulletins, and other materials sent to the providers.
• Works in a team effort on projects such as new start-ups, renewals, re-credentialing applications as required by Insurance carriers.
• Prepares documents in a consistent and accurate manner.
• Communicates information to input into Cactus and Epic system including new providers and updates of provider information using the appropriate forms.
• Responsible for working enrollment issues.
• Responsible for working provider enrollment claims in Epic.
• Follows department and Insurance payer guidelines for preparing documents in a consistent and accurate manner.
• Reports any detected problems, errors, and/or changes in provider enrollment requirements, when discovered.
• Understands and complies with department and organization policies and insurance carrier guidelines.
• Other duties as assigned.

Knowledge / Skills / Abilities

• Excellent written and verbal communication skills, customer service skills, including professional telephone skills.

• Good organizational skills and the ability to pay attention to detail.

• Self-motivated with good time management and organizational skills.

• Ability to read and interpret basic to moderately complex documents such as operating and maintenance instructions, procedure manuals, and government/healthcare guidelines.

Qualifications

Required

• Associate's degree in a related area of assignment, or equivalency.
• Three years of experience in professional support.

Qualifications (Preferred)

Preferred

• Provider Enrollment experience.
• Ability to multi-task in a busy office environment.
• Experience with Epic and Cactus system applications.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements