General Description of the Job Class

Record and generate a variety of information pertaining to the patient revenue process. An accurate, high-performance level position requires a certain degree of knowledge of complex rules and the corresponding ability to apply these rules in the work environment to achieve desired outcomes. 

Duties and Responsibilities of this Level:

Workload 85%

Fiscal Responsibility: Record or generate revenue by gathering and processing information that impacts the patient revenue process. Fiscal responsibility is measured on high production levels, and quality of work output, in compliance with established DUHS policy standards. May also be defined in t terms of the value of the work portfolio assigned and/or revenue expectations.

The Provider Enrollment (PE) Specialist is responsible for preparing and submitting enrollment applications and s supporting documentation to enroll individual physicians, physician groups, and hospitals. The PE Specialist researches and resolves billing issues related to Provider Enrollment. A variety of systems and external too ls are utilized to research and resolve provider enrollment issues. 

? Work closely with clinical departments on notification of a provider's start date, welcome packets, and provider documentation and ensure the providers are in all systems.

? Research and resolve bill holds related to provider enrollment.

? Update billing system to define billing and service provider effective and termination dates, create payer-specific bill holds, NPI and NPI subpart numbers, taxonomy codes, and pay er-specific provider numbers. Removal of bill holds after enrollment by the payer.

? Monitor and advise physicians and providers on license expirations.

? Perform follow- up with insurance payers via phone, email, or website to resolve provide enrollment issues.

? Monitor the completion and submission of provider enrollment applications for individual providers, clinics, and hospitals.

? Assign reminders and follow-up to ensure provider numbers are established and linked to the appropriate group entity promptly.

? Understand specific enrollment requirements for each payer and provider type including pre-requisites, forms required, form completion requirements, supporting documentation (DEA, CV, etc.), and regulations.

? Maintain documentation of enrollment packets or spreadsheets related to enrolling Physicians and the present status of the packet.

? Work provider enrollment denial work queues to ensure timely response for resolution and provide input to the Supervisor on denials we can reduce.

? Establish close working relationships with provider enrollment packet contacts, contracting department, clinical departments, and payer contacts.

? Respond to internal and external inquiries on routine enrollment, as appropriate.

? Interface regularly with in ternal staff in AR, registration, and Payer Relations.

? Review and resolve AR associated with enrollment denials and claim edits.

? Resolve AR associated with denials from payors and resolve per payor requests and guidelines.

? Maintain passing scores for internal control quarterly audits.

? Maintain work queues at less than one week of inventory without loss to timely filing.

? Limit the amount of transfers to other work queues.

? Mak e independent decisions for the accurate outcome of working claim edits, denials, no response follow-up, and correspondence documentation.

? Adhere to all PRMO and DUHS revenue cycle policies and regulations.

? Respect and maintain confidentiality regarding patient/guarantor financial data and patient medical data consistent with HIPAA standards.

? Clearly document write-off requests per policy with the appropriate pay code.  

? Adhere to DUHS badge swiping and time and attendance policies.

? Make process improvement suggestions to Management for daily tasks, to reduce inventory at a faster rate.

? Demonstrate the ability to use time management and organizational skills to maintain enrollment packet submission volumes and A/R thresholds.

? Proactively report trends and system-related problems to Management as soon as it is first noticed.

Workload 5%

Customer Service: Initiate and develop relationships with customers in order to gather and process information or resolve issues in order to receive accurate reimbursement and optimize internal and external customer satisfaction.

? Consistently respond to issues within two business days.

? Consistently respond to Supervisor /Team/Customer inquiries, providing appropriate feedback; and alleviating the need for unnecessary follow-up.

? Consistently demonstrate the ability to accept change within the team and department.

? Maintain minimal use of company phones, internet, and e-mail for personal usage within our policies and procedures.

? In caring for our patients, loved ones and each other maintain strict confidentiality of patient medical and financial records.

? Initiate and develop relationships with customers in order to gather and process information or resolve issues in order to receive accurate reimbursement and optimize internal and external customer satisfaction.

? Remain in satisfactory compliance with all existing policies and procedures.

? Maintain timely completion of the Hyland workflow process and Hyland medical records.

? Attend meetings and participate on committees, as assigned.

?Work with other PRMO Supervisors to improve collections, reduce accounts receivable, reduce denial rates, and reduce avoidable write-offs through issue identification, research, communication, and process improvement.

? Provide cross-coverage where support is needed.

? Volunteer to participate on committees to enhance custom er focus.

? Participate in cross-department initiatives and projects.

? Respond to customers in les s than one business day.

? Receive positive feedback/acknowledgment from internal and external customers.

? Identify significant customer service improvements.

? Provide detailed/accurate feedback when replying to inquiries.

? Always follow up with customers to ensure needs are being met.

Workload 10%

Clerical Duties: Operate general office equipment. Generates letters, work on spreadsheets; and enters and sorts data. Scope of Authority: Work independently and have the ability to make decisions relative to individual work activities. Accountable for individual work activities. Work assignments are defined by the immediate supervisor or manager. The job does not require the supervision of other employees in the unit.

? Attend and participate in meetings.

? Actively participate in departmental events.

? Support a positive team environment, by offering solutions to work-related concerns and referring teammates to management when an issue can't easily be resolved.

? Exhibit appropriate engagement in all that we do.

? Maintain go od attendance and dependability by Availability to Work Policy.

? Engage in frequent rounding conversations with all Management.

? Complete all safety training before the yearly renewal date/month.

? Comply with require d online safety training to include LMS.

? Actively participate in Work Culture initiatives based off of annual work culture scores and action plans. 

? Adhere to all PRMO and DUHS revenue cycle policies and regulations.

? Complete all annual online training before notification and without re minders from Management.

? No more than one unscheduled occurrence/tardy in the review period.

? Exemplary support of other team involvement and workflow needs from intern al and external customers.

? Engage in training and development via internal/external sources during the review period.

? Actively participate and promote a positive work culture.

? Exemplary rounding participation.

Scope of Authority:  Work independently and have the ability to make decisions relative to individual work activities. Ac countable for individual work activities. Work assignments are defined by the immediate supervisor or manager. The job does not require the supervision of other employees in the unit. 

Required Qualifications at this Level

Education: Work re quires knowledge of basic grammar and mathematical principles normally required through a high school education, with some postsecondary education preferred.  Additional training or working knowledge of related business.

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Experience: Two years' experience working in hospital access, physician office billing and collections, or an equivalent combination of relevant education and/or experience.

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Degrees, Licensure, and/or Certification: N/A 

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Knowledge, Skills, and Abilities: Excellent communication, oral and written skills. Ability to analyze data, perform multiple tasks, and work independently. Must be able to develop and maintain profession al, service-oriented working relationships with patients, physicians, co -workers, and supervisors. Must be able to understand and comply with policies and procedures.