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Title

Provider Enrollment Specialist (DH0109) 

About the Organization Thank you for your interest in exploring the professionally rewarding and personally fulfilling benefits with Tuba City Regional Health Care Corp. We look forward to continuing our discussion about the opportunity and purpose health professionals experience as valued members of TCRHCC team.

A TCRHCC career offers a chance to live and work within or near Native communities, providing clinicians/nurses/administrators with a unique opportunity to learn the heritage of the tribes we serve, discover traditions that have been carried down for generations and gain cultural insight into the beliefs and values of a deserving and appreciative patient population.
 
Description

POSITION SUMMARY

The primary purpose of this position is to enroll providers, clinicians, clinic locations, and clinical services with third party enrollment entities; such as Medicare, Medicaid, Commercial Insurance entities and the National Plan and Provider Enumeration System. The incumbent must analyze and use discretionary judgment in implementing provider enrollment guidelines to ensure all provider agreements and applications are accurate, current, and maintained.

ESSENTIAL FUNCTIONS:

  1. Prepares initial provider enrollment applications for submission by conferring with appropriate individuals and/or departments to verify information and collects appropriate licensure or certification information as required by the provider (i.e. Medicare, Medicaid, Commercial, National Provider Identifier, regulatory agencies, etc.).
  2. Researches conditions of participation upon notification of expansion of clinical services or location and prepares initial provider enrollment applications as required by the provider (i.e. Medicare, Medicaid, Commercial, National Provider Identifier, regulatory agencies, etc.).
  3. Responsible for submission of completed applications and for tracking the status of pending enrollment applications by utilizing available tools (i.e. on-line, telephone, internet, etc.) and addresses application discrepancies to ensure confirmation of enrollment.
  4. Audits all submitted applications by tracking coverage processing days for applications for initial enrollment, change of information and/or reassignments.
  5. Adheres and monitors latest changes in provider enrollment provisions; screening requirements, applicable enrollment fees, and compliance plans/requirements. Informs and educates inter and intra-departmental staff (i.e. supervisors, clinicians, providers, etc.) of changes.
  6. Assists clinical staff members in completing and processing provider enrollment applications. Provides education and orientation to clinical staff and guides them during the enrollment process. Develops reference and training material for inter and intra-departmental staff.
  7. Upon receipt of enrollment confirmation or provider separation/changes, enters appropriate provider numbers or changes into the patient accounting systems (i.e. provider maintenance) for third party billing requirements and maintains a comprehensive current list of provider enrollment numbers.
  8. Assists patient accounting staff in resolving discrepancies involving provider numbers and/or claims denials as a result of provider number issues.
  9. Assist with EHR Incentive Program Enrollments and Attestations for Meaningful Use.
  10. Ensure proper PPE is worn at all times while on duty including but not limited to, face mask, gloves, gown, isolation gown, NIOSH-approved N95 filtering facepiece respirator or higher, if available), and eye or face shield.
  11. Complete all donning and doffing tasks in a safe acceptable method and discard of used PPE accordingly. (see CDC website for most current updates)
  12. Complete task training for all routine cleaning and decontamination processes for all surfaces contaminated by a communicable disease to ensure a high level of patient, visitor, employee and external customer satisfaction.
  13. Performs other duties as assigned.

MENTAL AND PHYSICAL EFFORT

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

Physical:

The work is primarily sedentary: walk for short periods of time and sit for long periods of time as interaction between all disciplines within the facility is required, ability to stoop and pick up objects from the floor without restrictions, and have full use of hands and arms, i.e., to operate office equipment such as computer, printer, fax, etc.

Mental:

Must exercise a high degree of judgment and leadership in planning, organizing, staffing, directing, and evaluating the provider enrollment activities.  Mental attention and assertiveness are always required. The ability and willingness to learn new information is an expectation.

 
Position Requirements

NECESSARY QUALIFICATIONS

Education:

  • College courses/credits towards an Associate Degree in Business Administration, Allied Health or related field (finance, accounting, administration, nursing, etc.)
  • High School Diploma or GED

Experience:

  • Must have one (1) year general administrative experience in a patient accounting setting

Other Skills and Abilities:

A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas:

  • Positive working relationships with others
  • Possession of high ethical standards and no history of complaints
  • Has the ability to handle sensitive and confidential information
  • Professional and effective interaction skills with co-workers, clients, Providers, vendors
  • Ability to remain organized with multiple interruptions
  • Knowledge of the operations of the front-line staff in a medical practice
  • Excellent customer service skills
 
Close Date 12/4/2021  
EOE Statement The Tuba City Regional Health Care Corporation (TCRHCC) is committed to equal opportunity employment. In accordance with the Navajo Preference in Employment Act (NPEA) and TCRHCC policy, preference is given to qualified Navajo and Native American candidates. Those applicants requiring reasonable accommodations(s) during the application and/or interview process should notify a representative in the Human Resources Department.  
Exempt/Non-Exempt Non-Exempt  
Full-Time/Part-Time Full-Time  
Location Tuba City Regional Health Care Corporation  
Navajo/Indian Preference Applicants who are enrolled members of the Navajo Nation and who meet the necessary qualifications for this position will be given preference in hiring and employment for this position.  
Open Date 6/25/2021  

This position is currently accepting applications.

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