Payer Activation Specialist
Milwaukee, WI (On-site)
Posted 2 months ago
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Job Description
- Coordinates all application processes (application completion, provider communication, Epic provider set-up, etc.) regarding enrollments for Medicare, Railroad Medicare, Tricare, and Medicaid for professional providers and communicates all updates to appropriate areas.
- Responsible for maintaining knowledge of enrollment rules/forms/processes for National Provider Identifier (NPI), Medicare, Railroad Medicare, Tricare and Medicaid (including other state programs) for all provider types.
- Responsible for maintaining all expiration dates for all providers enrolled. Maintains enrollment and re-validation process. Maintains providers folders/files containing provider enrollment documents, signatures and forms while maintaining strict confidentiality.
- Collaborates with providers to apply for an NPI and perform updates/corrections on the National Plan and Provider Enumeration System (NPPES).
- Plans key communication with clinic operational leadership, provider affairs, managed care and credentialed verification team to ensure there are no lapses in provider enrollment that would result in loss of revenue.
- Serves as an expert to the hospital-based clinics, medical groups sites, revenue-producing hospital departments, third party payers, and other Revenue Cycle teams regarding enrollments and enrollment-related issues.
- Responsible for activating and maintaining all provider enrollment tables within Epic to ensure claims are released to the payers only once provider credentialing/enrollment finalized. Coordinates the resolution of claim edits related to NPI, CLIAs, tax IDs, and provider enrollment table.
- Acts as a liaison between clinic operational leadership and Advocate Physician Partners (APP) and the Center for Practitioner Information (CPI).
- Coordinates the resolution of denials related to enrollment issues. Collaborates with Advocate Physician Partners (APP) and the Center for Practitioner Information (CPI) on the resolution of denials related to non-credentialed providers. These denials occur from breakdown of communication of provider information between insurance carrier and Advocate Health Care.
- None Required.
- High School Graduate.
- Typically requires 5 years of experience in working with an automated patient accounting system.
- Strong understanding of governmental and insurance carrier credentialing process for providers and facilities.
- Knowledge of current Medicare/Medicaid payor guidelines and requirements.
- Strong analytical, organizational, and communication skills essential.
- Must have ability to function in a multi-disciplinary environment.
- PECOS experience
- MD-Staff experience
- Experience working with IL and WI Medicare and Medicaid websites
- Must be able to sit for extended periods of time.
- Position requires travel; therefore, incumbent may be exposed to road and weather conditions.
- Generally exposed to a normal office environment.
- Operates all equipment necessary to perform the job.
Aurora Health Care
Aurora Health Care is proud to be a part of Advocate Health, the third-largest nonprofit integrated health system in the U.S.Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs nearly 150,000 team members across 68 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides nearly $5 billion in annual community benefits. Learn more: advocatehealth.orgRead our social media community engagement guidelines: aah.org/social
