Provider Enrollment Claims Specialist

    Community Health System
    Franklin, TN 37064
    Full-time
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    Job Description

    Summary: The Provider Enrollment Claims Specialist is responsible for working collaboratively with internal and external stakeholders to research and resolve claims on hold and denial trends due to provider enrollment issues.

    Community Health Systems, Inc. is one of the nation's leading operators of general acute care hospitals. The organization's affiliates own, operate or lease 89 hospitals in 16 states with approximately 15,000 licensed beds. Affiliated hospitals are dedicated to providing quality healthcare for local residents and contribute to the economic development of their communities. Based on the unique needs of each community served, these hospitals offer a wide range of diagnostic, medical and surgical services in inpatient and outpatient settings.

    CHSPSC, LLC seeks a Provider Enrollment Claims Specialist for its headquarters' Medical Staff Development team.

    Summary:

    The Provider Enrollment Claims Specialist is responsible for working collaboratively with internal and external stakeholders to research and resolve claims on hold and denial trends due to provider enrollment issues.

    Essential Duties and Responsibilities include the following. Other duties may be assigned
    • Serve as a liaison between Provider Enrollment, A/R, and the payers on troubleshooting claim holds and denials due to provider enrollment issues.
    • Closely monitors hold reports generated by A/R to identify enrollment-related claims impacts and denial trends
    • Regularly contacts payers to identify provider enrollment issues and communicate for resolution.
    • Identifies potential trends in holds/denials by the payer or by type, denial reason, or coding issue and reports to provider enrollment management and/or A/R for appropriate escalation.
    • Collaborates internally and externally to proactively research the root cause of held claims and claim denials to ensure that payer information and enrollment requirements are accurate.
    • Uses critical thinking skills and payer knowledge to recommend system edits to reduce holds/denials and result in prompt and accurate payments.
    • Recognizes when additional assistance is needed to resolve provider enrollment claim holds/denials and escalates appropriately and timely through defined communication and escalation channels.
    • Organizes, prioritizes, and performs requests from management and cross-functional teams
    • Able to manage multiple projects simultaneously and under tight deadlines.
    • Perform other duties as assigned
    Qualifications:

    To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
    • Knowledge of word processing software, spreadsheet software, and database software.
    • Ability to define problems, collect data, establish facts, and draw valid conclusions.
    • Must be self-motivated and able to communicate well with others in person, via written communication, and telephonically.
    • Must be able to perform each essential duty satisfactorily.
    • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
    Reasoning Ability:

    Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.

    Computer Skills:

    To perform this job successfully, an individual should have knowledge of Word Processing software; Spreadsheet software and Database software.

    Physical Demands:

    The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    Education/Experience:

    High school diploma or general education degree (GED); 2 years of claim resolution or provider enrollment experience; or equivalent combin

    Posting ID: 593549354Posted: 2021-02-25Job Title: Provider Enrollment Claim Specialist