O&P Provider Enrollment Specialist in Tampa, FL at Shriners Hospitals for Children

Date Posted: 10/8/2019

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    2900 North Rocky Point Drive
    Tampa, FL
  • Job Type:
  • Experience:
    At least 1 year(s)
  • Date Posted:
    10/8/2019

Job Description

As part of the Shriners Hospitals for Children Home Office O&P department, the O&P Provider Enrollment Specialist is responsible for coordinating, monitoring and maintaining enrollment of multiple DME facilities throughout the country and re-enrollment (when needed) for the Pediatric Orthotic & Prosthetic Services (“POPS") locations and practitioners’ / providers’ participation in all third party and government insurance.  The O&P Provider Enrollment Specialist will continuously exemplify the mission, vision, values and customer service philosophy of Shriners Hospitals for Children in job performance and in service to other persons outside of and throughout the organization.

POSITION RESPONSIBILITIES:

  • Manages the completion and submission of DME facility enrollment applications for all insurance types, including enrollment and reassignment of Medicare and Medicaid programs.

  • Serves as point of contact for POPS Locations with regards to questions on Medicare / Medicaid provider enrollments. Addresses inquiries in a timely manner and includes appropriate personnel in other departments as appropriate, to ensure that the hospitals obtain complete and accurate information to their enrollment questions and concerns. Exercises independent judgment to escalate issues as appropriate.

  • Processes and reviews provider enrollment applications and Medicaid / Medicare enrollment applications that require signature by corporate officers or managers for the O&P department and POPS. Compiles and maintains repository of Medicaid / Medicare and commercial payor ID’s for all POPS Locations, including effective dates, revalidations, and renewal dates

  • Researches practitioner enrollment processes, when needed, for enrollment to ensure applications are filled out accurately. Provides feedback and requests revisions as necessary prior to obtaining signatures by corporate executives.

  • Implements and maintains tracking tools to record status of all applications processed for signature by corporate executives.

  • Coordinates and performs follow-up with insurance payers via phone, email, fax or website to resolve provider enrollment issues and ensure timely revalidations.

  • Coordinates communication with Home Office O&P team (O&P Contracting Manager, O&P Billing Supervisor, Corporate Director of O&P, and O&P Administrative Assistant) as well as any Headquarters departments (compliance, legal) and Shriners Hospitals for Children leadership.

  • Works closely with O&P Contracting Manager and the external provider enrollment departments (insurance based) to discern specific application/enrollment requirements including pre-requisites, forms required, form completion requirements, timelines, supporting documentation, and regulations.

  • Maintains ongoing current assignment spreadsheets and reporting related to completed provider enrollments, provider enrollments in process and revalidation timelines / processes.

  • Works closely with executive leadership, and appropriate local POPS Staff/leadership to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc.

Job Requirements

The qualified candidate will have experience in the following areas

  • 1 or more years of provider enrollment or credentialing experience required

  • Expertise with AdobePro and MS Office products (Excel, Word, PowerPoint, Outlook) required

  • Experience with Medicare, State Medicaid, and third party practitioner enrollment required

  • DME experience preferred

Minimum Education Required/Preferred:

  • High School diploma or GED required

  • 2 years of college preferred

Knowledge, Skills, and Competencies:

  • Ability to work autonomously (organized self-starter requiring little supervision to focus on and accomplish required tasks)

  • Ability to adapt to flexible work schedules and frequent interruptions

  • Ability to problem solve, make decisions and effectively communicate issues and progress

  • Knowledge of healthcare environment and healthcare delivery systems

  • Knowledge of medical provider credentialing procedures and standards

  • Database management skills including querying, reporting, and document generation

  • Must have excellent computer skills (documentation, database management, spreadsheets, etc.) 

  • Maintains strict confidentiality with regard to provider information and understand/adheres to sound physicians HIPAA Privacy & Security policies and procedures

  • Must be able to communicate well with a wide variety of contacts at all levels of the organization

  • Must be able to work cohesively in a team oriented environment and be able to foster good working relationships with others both within and outside the organization

  • Strong Knowledge of Medicaid, Medicare and commercial insurance preferred

  • Well-organized, detail oriented and able to meet deadlines with minimal errors

  • Strong written, phone, and verbal communication skills; proven ability to communicate with doctors, hospital administrative and credentialing staffs

  • Able to plan, organize, and manage multiple tasks concurrently