Payer Enrollment Specialist

Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work? Entity: Corporate Services

Department: Medical Affairs \- Admin

Location: 3535 Market Street 14th Floor

Hours: Remote, M\-F, 7am\-3:30pm

\\This position requires occasional in\-office trainings\\

Payer Enrollment Specialist

Individual will be part of a team responsible for the enrollment of Penn Medicine billable (employed/contracted) practitioners with contracted health plans to ensure Penn Medicine's ability to bill and receive reimbursement for services rendered to patients. Includes understanding and complying with the enrollment processes of assigned health plans, researching and resolving enrollment related issues, and communicating with internal and external clients. The individual will be responsible for initiating the enrollment process and tracking it to completion with assigned health plan(s).

Accountabilities

• 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

Minimum Requirements

Required Education and Experience

• 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

Required Skills and Abilities

• TECHNOLOGY: Ability to use Microsoft Word
• TECHNOLOGY: Ability to use Microsoft Excel
• TECHNOLOGY: 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

We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

Live Your Life's Work

We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.