Provider Enrollment Specialist - Managed Care **Galveston, Texas, United States** **New** 1. Select the Job Field UTMB Health Requisition # 2500439 **Required Education / Experience:** Associate’sDegreeorequivalentandthree years of financial, credentialing, billing, or related experience in a healthcare organization. **Job Description:** The Provider Enrollment Specialist is responsible for coordinating, monitoring and maintaining the provider enrollment and re-enrollment process in a timely and compliant manner with all government and commercial payors. Facilitates all aspects of provider enrollment, including initial enrollment, re-enrollment, monitoring, and appointment for the medical staff and allied health practitioners. Assists with problem identification and timely resolution of payor related issues surrounding claim submission and denial management to ensure optimal reimbursement. Position serves as the liaison between managed care plans and UTMB, including Revenue Cycle Operations and the Faculty Group Practice, to resolve any billing issues related to provider enrollment and promote optimal reimbursement. **Essential Job Functions:** + FacilitateenrollmentofnewUTMBproviderstoensureproperandtimelybillingand collections + PrepareenrollmentapplicationsforallhealthplansincludingMedicareandMedicaid + Completedataentryandprocessingof enrollmentapplications,withvalidationof provider submittedinformationtoensuretheapplication is complete,accurate,andmeetingUTMB standards + Obtainlicensure,certificationandinsurancecertificatesattimeofenrollmentandmaintainindatabaseinordertosubmitwithenrollmentapplications + Maintain timelinesonenrollmentprocesses,andaddress and/or escalate anydelays + Ensurethatallpendingenrollmentsarereviewed,obtainedandmanaged accordingto therulesandpoliciesofthedepartment + Providemonthlynotificationof newproviders, resignations,and changes inprovider status suchaspracticelocationsandpanel statusto contractedplans + Followupwithnecessarycontacts,includingprovidersandmanagedcareorganizations, toresolveenrollmentapplicationissuesanddeficiencies + Facilitateresolutionofproviderrelateddenials toensureappealproceduresarefollowed toresultinproperreimbursement + Demonstratealevelofcompetenceandunderstandingofallstateandfederallaws, rulesandregulationsaccordingtopayerguidelinesforbilling + Respondtointernalandexternalinquiriesonroutineenrollmentandcontractmatters,as appropriate + Performdetailedfollow-upactivitiesonassignedaccountsaccordingtoprocedures + ResolveoutstandingAR accountsat adefinedlevelofproductivity + Maintainconfidentialityofallproviderenrollmentbusiness/workandmedicalstaff information **Marginal Or Periodic Job Functions:** + Prioritizeandcompleteallworkinanaccurate,effectiveandefficientmanner + Participateinteammeetings/activitiesandsupportthephilosophyandgoalsoftheteamanddepartment + Participateinspecialprojects/assignments + Readallannouncementsandrelevantcommunicationsrelatingtojobduties + Successfullycompletecompetencybasedtrainingandtesting + Performrelateddutiesasrequired **Knowledge/Skills/Abilities:** + Knowledgeofinsuranceclaimprocessingandthirdpartyreimbursement. + Knowledgeofstateand federalregulationsastheypertaintobillingprocessesand procedures. + Abilitytounderstandandinterpretstatisticalreportsandperformquantitativeanalysis. + KnowledgeoftheprinciplesofInformationSystemsinordertoeffectivelyanalyzeandmakedecisions,preferablywith experienceinEpicanddatabasemanagement. + Skillineffectiveoral,written,andinterpersonalcommunication. + Skillintimemanagementandprojectmanagement. + Abilitytoworkefficientlyunderpressure. + Abilitytooperateacomputerandrelatedapplications. + Abilitytoworkindependentlyandtakeinitiative. + Abilitytodemonstrateacommitmenttocontinuouslearningandtooperationalizethat learning. + Abilitytodealeffectivelywithconstantchangesandbeachangeagent. + Abilitytodealeffectivelywithchallengingsituations. + Abilitytowillinglyacceptresponsibilityand/ordelegateresponsibility. **Salary Range:** Actual salary commensurate with experience. **Equal Employment Opportunity** UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a VEVRAA Federal Contractor, UTMB Health takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities. Compensation