Sanford Health Provider Enrollment Representative - Provider Enrollment in Sioux Falls, South Dakota
Job Title: Provider Enrollment Representative | Provider Enrollment | Fargo, ND or Sioux Falls, SD
City: Sioux Falls
Department : Provider Enrollment
Job Schedule: Full Time
Hours Per Shift: 8 hr
Primary function is to enroll new providers with payors as well as new facility sites. Re-enroll existing providers and facility sites with payors. Obtain provider number(s)/effective dates for billing purposes. Apply for individual practitioner and/or facility national provider identifier (NPI) via national plan and provider enumeration system (NPPES). Maintain practitioner and facility files with accurate and up-to-date data. Notify payors and internal contacts of practitioner practice changes, including terminations, cases of malpractice, or other legal matters. Respond to research issues received thru internal or external contacts. Review charges/claims pending report. Enrollment for electronic claims submission. Updating and maintaining provider numbers and related data in both internal and external billing software and production programs. Maintain supporting documentation such as a W-9, CLIA certificate, bank, IRS, and CMS letters as applicable. Attend site planning meetings to provide input, gather necessary information for set up, and provide updates. Notify payors of site notification for payors (i.e., for new sites, site terminations, and changes).
Knowledge in credentialing/enrollment process for payors. General knowledge of Primary Source Verification process. Microsoft Office products, particularly Outlook, Word, and Excel. General understanding of company goals and objectives. Computer skills, in-depth problem solving and research skills. Prioritize tasks/time management. Decision making skills. Maintain confidentiality of information.Organization/prioritization skills. Ability to work both independently and with a group. Excellent oral, written, and interpersonal communication skills.Professionalism and flexible/adaptable team player.
The hours for this position are 8-4:30 p.m., Monday through Friday.
Associates Degree is required. Equivalent work experience in a health care field organization is preferred including prior insurance billing, provider enrollment or credentialing experience.
About Sanford Health:
At Sanford Health, we are dedicated to the work of health and healing. Every day, we show that commitment by delivering the highest quality of care to the communities we serve. We are leaders in health care and strive to provide patients across the region with convenient access to expert medical care, leading-edge technologies and world-class facilities.
In addition to strong clinical care, we are also committed to research, education and community growth. We engage in medical research to not only discover innovative ways to provide care, but also cures for common diseases. We continuously seek new ways to achieve our vision of improving the human condition here in your community, across the region and around the world.
The entire team at Sanford Health recognizes the value of healthy families and communities. We continue to gain momentum and expand our reach. Together, we can make a positive difference now, and in the future.
Sanford is an EEO/AA Employer M/F/Disability/Vet. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-673-0854 or send an email to firstname.lastname@example.org .
In compliance with federal law requiring employers to verify new employees' U.S.
employment eligibility, Sanford participates in E-Verify. To learn more click here for English Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterEnglish.pdf or here for Spanish Version at https://e-verify.uscis.gov/emp/media/resourcesContents/EverifyPosterSpanish.pdf .
Job Function: Revenue Cycle
Job Schedule: Full Time
Req Number: req20426