Location: Jacksonville, FL
Company: Nemours Children's Health System
managed care networks and government payors that the organization is contracted with, or has an agreement with, for the reimbursement of services. This position has continuous contact with internal and external customers, including physicians and other healthcare providers, administrators, support staff and network representatives.
Additionally, this position is responsible for communication provider participation information to stated internal and external customers through established processes to allow for appropriate patient scheduling and reimbursement for services rendered. Schedules/cancels/reschedules and confirms patient appointments with courtesy, providing assistance and information
as needed. Accurately complete the enrollment/ re-enrollment processes as outlined by each network/area for all appropriate healthcare providers. These will be identified through department policies, network reimbursement and delegated contracts to ensure timely and continued provider network participation.
Maintain detailed provider enrollment files in electronic format, including electronically received documents and scanned hardcopy documents, while appropriately following each stage of the enrollment/re-enrollment process thoroughly and respecting Nemours process for PHI. Accurately maintain all internal systems with the appropriate provider and network participation information.
Systems including, but not limited to, ECHO, Excel, PET Tracker, i Guide, Qliksense, the NPL tracker, internet, Outlook and word processing.
Performs follow up with health plans and their representatives in order to expedite participation approval by each health plan. Develop and maintain good working relationships with Nemours providers and support staff to obtain necessary and timely information and to facilitate the provider enrollment/re-enrollment process. Develop and maintain relationships with Network Representatives in order to facilitate the provider enrollment/re-enrollment processes. Responsible for sending enrollment applications to providers, as appropriate, in order to maintain signatures and demographic information.
Work collaboratively with fellow team members to create, evaluate and maintain department workflows, processes, policies and systems. Additionally, eavh team member is expected to cross train on plan requirements to assist one (or more) other team member in completing assigned duties. Will assist with special priority projects and other miscellaneous duties and responsibilities, as assigned my employee's supervisor or department leadership. Job Requirements Associate Degree or equivalent work experience in the field of provider enrollment or similar field required.
Minimum one (1) year of experience required. PDN-9acfc2d0-f-80b900a32a33
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