Provider Enrollment Specialist
- Job Title
- Provider Enrollment Specialist
- Job ID
- 27742787
- Work Hybrid
- Yes
- Location
- Austin, TX, 78744 Hybrid
- Other Location
- Description
-
Tenderheart Health Outcomes (THO) is a Durable Medical Equipment supplier serving the Medicaid population in Texas and other states. We provide incontinence and other supplies to over 45,000 patients a month. Through our personalized coaching and frequent patient interaction, we decrease the likelihood of adverse patient outcomes, helping patients live happier, confident and more independent lives with a higher level of patient satisfaction. Because of these better outcomes and our value-based model, managed care organizations (MCOs) realize substantial savings while also improving the health of their patients.
Position: The Billing Department is looking to fill a full-time position as Provider Enrollment Specialist. This person will confirm that the ordering provider is actively enrolled with the Texas Medicaid program. When an inactive provider is identified, this person will call the patient to ask if they have an alternative provider. We provide instructions on seeking an alternative provider as most patients are unaware of their provider’s Medicaid enrollment status.
QUALIFICATIONS- High school diploma or general education degree (GED)
- 3 months related industry experience and/or training; or equivalent combination of education and experience.
- Prior, successful experience with Call Center or Delinquent Collections strongly preferred.
- The ideal candidate will have 3 or more years’ experience in DME operations. Prior experience in a call center or other high stress occupation is a plus. Prior experience with our operating system, Brightree, is a plus.
Requirements
Must demonstrate proficient ability and practical knowledge of computers, software, and products applicable to the industry. Ability to navigate and perform daily work in Word, Excel, Adobe and payor web portals. Prior experience with Brightree or other DME billing software preferred. Additionally, the employee is expected to demonstrate the ability to quickly acquire knowledge of departmental program structure (Mission, Vision, and Goal Statements) and department policies and procedures. Must be able to work a flexible schedule, as needed, and should have the ability to demonstrate effective time management skills while working independently with minimal supervision. This position reports directly to the Revenue Cycle Manager.
Duties- Verify and update ordering provider eligibility in the Texas Medicaid program via website or telephone. If the provider is not eligible under the Texas Medicaid program, contact provider’s clinic or patient for possible alternative ordering provider.
- Verify and update member eligibility records, benefits, and provider information to ensure accurate referral and authorization determination and accuracy of claims and capitation payments.
- Research and review monthly shipments and authorization for eligibility
- Forward eligibility determination to the billing department to be reviewed, updated, and processed.
- Update claims with eligible member information or declined and deferred to the proper payor.
- Disable template if eligibility is not determined. Report all deferred claims and supporting documentation with clear instructions to patient file on the reason for determination
- Process deceased patient tasks
- Process insurance change tasks
- Process patient in nursing home (HCA) tasks
- Special projects assigned by management
- Participate in Improvement of Operational Performance (IOP) activities.
- Participate in traditional and e-learning programs.
- Collaborate effectively with other company employees, managers, and departments.
- Perform all job functions with Company Mission, Vision, Values in mind.
- All other duties as assigned
Tenderheart Health Outcomes provides a hybrid work schedule with at least one day per week required in the office. THO has physical offices in Austin and San Antonio, Texas; St. Louis, Missouri; Albany, New York; and Dothan, Alabama. The pay range is $18 - $20 per hour.
Benefits- Mentorship opportunities
- Collaborative and inclusive work environment
- Professional growth and development
- 401(k)
- 401(k) matching
- Dental/vison insurance
- Health insurance
- Paid time off
- Referral program
