University of Texas Rio Grande Valley PROVIDER ENROLLMENT SPECIALIST in Harlingen, Texas

Scope of Job

Coordinate, monitor and maintain the provider enrollment and re-enrollment processes in a timely and compliant manner with all government and commercial payors.

Description of Duties

  • Facilitates all aspects of provider enrollment, including initial enrollment, re-enrollment, and monitoring of all providers to ensure proper and timely billing and collections.

  • Prepares enrollment applications for all health plans including Medicare and Medicaid.

  • Maintains timelines on enrollment processes and address and/or escalate any delays.

  • Ensures that all pending enrollments are reviewed, obtained and managed according to the rules and policies of the department.

  • Provides monthly notification of new providers, resignations and changes in provider status such as practice locations and panel status to contracted plans.

  • Follows up with necessary contacts, including providers and managed care organizations, to resolve enrollment application issues and deficiencies.

  • Assists with resolution of provider related denials to ensure appeal procedures are followed to result in proper reimbursement.

  • Assists with problem identification and timely resolution of payor related issues.

  • Responds to internal and external inquiries on routine enrollment and contract matters, as appropriate.

  • Performs detailed follow-up activities on assigned accounts according to procedures.

  • Maintains confidentiality of all provider enrollment business/work and medical staff information.

  • Participates in special projects/assignments.

  • Performs other duties as assigned.

Required Experience

  • Three (3) years of financial, credentialing, billing or related experience in a healthcare organization, or

  • Five (5) years of the required experience with a High School Diploma.

Working Conditions

Needs to be able to successfully perform all required duties. Office Environment; some travel to clinic sites to obtain enrollment documentation and weekend work may be required.

Other

Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.

EEO Statement

UTRGV is an Affirmative Action/Equal Opportunity Employer that strives to hire without regard to race, color, national origin, sex, age, religion, disability, sexual orientation, gender identity or expression, genetic information or veteran status. UTRGV takes affirmative action to hire and advance women, minorities, protected veterans and individuals with disabilities.

Special Instructions to Applicants

Dear Applicant,

Human Resources will not be held responsible for redacting any confidential information from the documents you attach with your application. The confidential information includes the following:

*Date of Birth *Gender *Ethnicity/Race

Please make sure that you omit this information prior to submission. We are advising that Human Resources will be forwarding your application to the department as per your submission. The University of Texas Rio Grande Valley reserves the right to discontinue accepting applications prior to the stated close date of this position, after meeting the posting requirement of three (3) calendar days.

If you have any questions, please do not hesitate to contact us at (956)665-2451 and/or careers@utrgv.edu.

Additional Information

UTRGV is a distributed location institution and working location is subject to change based on need.

All UTRGV employees are required to have a criminal background check (CBC). Incomplete applications will not be considered.

Substitutions to the above requirements must have prior approval from the Chief Human Resources Officer.

Posting Number: SRGV3375

Working Title: PROVIDER ENROLLMENT SPECIALIST

Number of Vacancies: 1

Location: Harlingen, Texas

Department: School of Medicine / Clinical Affairs

FLSA: Non-Exempt

Supervision Received: General supervision from assigned supervisor.

Supervision Given: Direct supervision of assigned staff.

Required Education: Associates degree in Business Administration or closely related field.

Preferred Education: N/A

Licenses/Certifications: None.

Preferred Experience: N/A

Equipment: Use of standard office equipment.

Physical Capabilities: N/A

Employment Category: Full-Time

Minimum Salary: Commensurate with Experience

Posted Salary: Commensurate with Experience

Position Available Date: 04/20/2018

Grant Funded Position: No