Billing and Provider Enrollment Coordinator

OHC Business Office · RAPID CITY, South Dakota
Department OHC Business Office
Employment Type Full-Time
Minimum Experience Mid-level

 

GPTLHB IS A MANDATORY VACCINATION ORGANIZATION THE EMPLOYEE IS RESPONSIBLE FOR PROVIDING PROOF OF INOCULATIONS BEFORE EMPLOYMENT


 Job Summary:     

                                                                                                                                                                            

The Billing and Provider Enrollment Coordinator is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing packages as required by commercial payers, Medicare and Medicaid. The BPE Coordinator will also perform a variety of business office duties to ensure revenue cycle is complete and maximum reimbursement from all third party insurance payers is collected. This position requires above average organizational skills, ability to plan and prioritize to meet deadlines, data entry skills, confidentiality, technical competence, and knowledge of provider credentialing and its direct impact on the practice’s revenue cycle. While there is a heavy emphasis on provider enrollment, this position is multi-functional and the incumbent must be able to learn and apply different aspects of Tribal healthcare billing practices.


Essential Functions:                                                                                                                                                                       


Specific duties include, but are not limited to:

  • Maintain individual provider files to include up to date information needed to complete the required governmental and commercial payer credentialing applications
  • Maintain internal provider grid to ensure all information is accurate and logins are available
  • Update each provider’s CAQH database file timely according to the schedule publishedby CMS
  • Apply for and renew annually all provider licenses; Professional, DEA, Controlled Substance
  • Complete revalidation requests issued by government payers
  • Complete credentialing applications to add providers to commercial payers, Medicare, and Medicaid
  • Complete re-credentialing applications for commercial payers, Medicare, and Medicaid
  • Work closely with the Revenue Cycle Director and billing staff to identify and resolve any denials or authorization issues related to provider credentialing
  • Assists billing department with claims processes including denial resolution
  • Maintain accurate provider profiles on CAQH, PECOS, NPPES, and CMS databases
  • Ability to work independently or with minimal
  • Excellent customer service skills; communicates clearly and effectively
  • Other duties as assigned


Professional Behavior


  • Effectively plan and organize workload and schedule time to meet the demands of the position.
  • Work in a cooperative and professional manner with GPTCHB
  • Treat Great Plains tribes and collaborators with dignity and
  • Utilize effective verbal and written communication
  • Abide by the GPTCHB policies, procedures, and
  • Attend GPTCHB meetings, events, and other functions as
  • Advance personal educational development by attending training sessions and seminars as appropriate.
  • Other duties as assigned by the Business Office Manager.

 

 Requirements                                                                                                                                                                                 


  • Exemplify excellent customer service with tribal stakeholders, health board colleagues, program partners, service recipients, visitors and
  • Foster a work environment of wellness, courtesy, friendliness, helpfulness
  • Relate well and work collaboratively with coworkers and all levels of staff in a professional manner.
  • Familiarity and/or experience working with American Indian populations and respect for and knowledge of traditional, cultural and spiritual practices of diverse American Indian communities, as well as an ability to work with other culturally and ethnically diverse populations.
  • Consistently demonstrate respect for and acceptance of differing capabilities, cultures, gender, age, sexual orientation and/or
  • Maintain and ensure organizational privacy and
  • Must be able to handle crisis and tolerate stress
  • Must be self-directed and take proactive initiative to assist
  • Possess the ability to resolve issues with other departments and coworkers without direct supervision.
  • Able to exercise flexibility to alter plans/routines when situations require and continue to perform without projecting stress/frustration that would adversely affect the work environment.
  • Ability to maintain a flexible work schedule, including evenings, weekends and overnight or extended travel as
  • Ability to effectively present information in one-on-one and small group situations to community members, consumers and other employees of the
  • Proficiency with computer programs (Word, Excel, PowerPoint) and other Internet technologies.
  • Valid driver’s license must be kept current, and certificates, credentials or licenses must be kept current and consistent with regulations required by applicable federal, state and/or grant regulations.
  • Ability to promote an alcohol-, tobacco- and drug-free
  • Embrace modes of appearance and attire that reflect a professional
  • Adhere to GPTCHB policies and

 

 Education/Experience/Certificates/Credentials                                                                                                               

  • Associate’s degree and one (1) year of relevant experience or high school diploma or GED and three (3) years of relevant experience
  • Minimum 2 years of experience in provider credentialing/enrollment with government and private insurance payers
  • Current knowledge of medical licensing and certification requirements
  • Understanding of current healthcare laws and regulations
  • Recognize credentialing guidelines of various organizations
  • Demonstrated technical competence to use CAQH, PECOS, NPPES, CMS andrelated databases
  • Familiar with ICD-10, HCPCS and CPT coding principles and regulatory guidelines related to outpatient coding and
  • Training and/or experience with computer data
  • Training and/or experience with the use of EHR/EMR.
  • Ability to maintain confidentiality under HIPAA
  • Ability to exercise a high degree of diplomacy and tact with excellent customer service
  • Ability to understand and follow
  • Must be a self-starter, motivated and able to multi-task.
  • Ability to perform with a high level of attention to
  • Computer and technical skills (including Word, PowerPoint, Excel, Outlook, ).
  • Previous IHS or Tribal Program experience
  • Experience that indicates the ability to interact effectively with leaders among American Indian communities, government agencies, scientific and academic communities, medical and health- related organizations, nongovernmental groups and the public at large is


Work Environment/Physical Demands                                                                                                                                 

The characteristic demands described here are representative of those that must be met by an employee to successfully perform the essential functions of the job.

While performing the duties of this job, the employee is frequently required to stand, walk, sit and use hands to finger, handle or feel. The employee is often required to stoop, kneel, crouch or crawl. The employee must regularly lift and/or move up to 25 pounds and frequently lift and/or move up to 50 pounds. The employee is occasionally exposed to outside weather conditions. The noise level in the work environment is usually moderate.


Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

 

Travel: Local and moderate out-of-town travel may be required.

 

Native American/American Indian Preference in hiring will be applied as defined in title 25 usc 44-46 &474.

 

Employment is contingent upon the outcome of all required criminal background checks.

Thank You

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  • Location
    RAPID CITY, South Dakota
  • Department
    OHC Business Office
  • Employment Type
    Full-Time
  • Minimum Experience
    Mid-level