Enrollment & Billing Representative jobs in Lancaster, PA

Our Mission, Vision, & Model of Care

At Union Community Care, our purpose is to spark equity through patient-led healthcare that welcomes and strengthens our communities by integrating body, mind, and heart.

We envision vibrant and healthy communities supported by inclusive healthcare that embraces each member’s unique culture, needs, and values, and emboldens them to make healthful choices that fuel their well-being and the well-being of others.

We believe in whole health. This means we address and heal disease but equally important, we work at the causes of the causes, the social ills that must be addressed to achieve true equity.

We listen, learn, and embrace the complex lives and unique strengths of our patients, and we work hard to break down all barriers to care. This means we look through a grassroots lens. We connect with our communities because we are our communities. Each of us is a neighbor, a friend, a family member, and together, we are a trusted community health center.

Job Duties:

• Completing all initial payer enrollment applications for commercial and government payers.
• Completing and maintaining all CAQH profiles for all providers
• Completing timely follow up on all payer enrollment applications
• Payer portal access
• Ensuring that re-credentialing and revalidations are completed timely to prevent any lapse in enrollment
• The loading and timely maintenance of credentialing and billing information in the billing and Credentialing/enrollment system the S Drive and/or MedTrainer
• Communicating with hospitals, payers, providers, and other entities to quickly and accurately obtain or provide information beneficial to the credentialing or enrollment needs of the organization
• Maintaining knowledge of current health plan and agency requirements for credentialing
• Ensuring practice addresses are current with government and commercial health plans, agencies and other entities
• Maintaining confidentiality of provider information
• Terminating enrollment with government and commercial payers upon resignation or termination of providers
• Updating and maintaining National Provider Identification files for providers
• Using the electronic billing system, along with any of the organization’s proprietary spreadsheets or software, purchased or leased, as the primary source of immediate notification and maintenance of enrollment related data
• Responding to the enrollment services dashboard tasks and overall maintenance and content
• Communicating with Athena Health Enrollment Services as needed both verbally or through tasks and cases
• Monitoring worklists to identify increases in accounts receivable or claims denials related to enrollment and credentialing issues, and working toward resolution
• Collaborate with Billing Specialist on any issues related to payer enrollment.
• Performs other work-related duties, as assigned

Qualifications, Skills and Knowledge Required:

• 3 years minimum experience in a payer enrollment related field
• Knowledge of Healthcare Billing systems (Athena preferred)
• Knowledge and thorough understanding of managed care operations including enrollment, credentialing, contracting and claims
• Knowledge of payer processes, local, state, and federal requirements
• Excellent written and oral communication skills
• Knowledge of Microsoft Office products, advanced in Excel
• Strong organizational, problem solving and decision-making skills
• Ability to prioritize and manage multiple projects and issues effectively and simultaneously
• Self-motivated and self-starter who can work well under minimal supervision
• Strong attention to detail, research and follow up skills
• Ability to work both independently and in a team setting

Keywords

• Payor Enrollment
• CAQH
• Medicare/Medicaid
• Healthcare Billing
• Insurance physician enrollment

ESSENTIAL FUNCTIONS

In order to fulfill the requirements of this position, duties 1-18 are considered essential functions of the job.

ORGANIZATIONAL INVOLVEMENT

This position is required to participate in mandatory all staff meetings, team meetings and trainings.