Our Client, a Retail Pharmacy company, is looking for a Provider Enrollment Coordinator for their Remote location. Responsibilities: + The Coordinator III will work directly with other coordinators to ensure quality of work delivered, performance/productivity benchmarks are met, and all compliance related issues are properly addressed, trained and coached on a consistent basis. + Ensuring timely and accurate processing of Payer Enrollment applications (Initial and Revalidations) for Clinics and Providers. + Provide quality control for timely and accurate individual enrollment applications submitted for Medicare and Medicaid programs. + Resolve claims issues for individual payers in corporate billing system. + Researching, completing and maintaining compliance with individual Government payers through credentialing, re-credentialing and audit processes and procedures. + Contact Providers when Revalidation notices are received in order to obtain signature pages and validate current general information. Interact with the field (SPM and CPMs) in regards to escalation notices. + The Payer Enrollment Coordinator will be responsible for identifying and quantifying trends/issues and then effectively communicating them to the appropriate members of the management team along with what the potential impact could be. + Minimize denials and deactivation of government applications where applicable to reduce key metrics including DSO, cost to collect, percent of aged claims, and Bad Debt. + Update Credentialing and Billing systems with Provider information upon inquiry or receipt from Government /Commercial payers. + The Enrollment Coordinators play a critical role in working with our new member clients to determine eligibility and perform various enrollment activities. + Enrollment Coordinators interface with both individual plan members and employer group and requires a strong focus around accurate and timely customer support to ensure client enrollment and retention. + The Enrollment Coordinator III reports directly to the Enrollment Supervisor, also functioning as SME (Subject Matter Expert) in the functions, processes, and eligibility procedures as they relate to Medicare Part D enrollment and CMS (Center for Medicare/Medicaid Services) Standards. + Complete, maintain, and monitor applications for Initial enrollment and Revalidation with Government Payers and some Commercial for Clinics and Providers in order to ensure active participation in Medicare and Medicaid programs. + Maintain working knowledge of statutory regulations for Medicare, Medicaid, and Commercial enrollment and claims submission requirements. + Ensure timely and accurate Group/Provider enrollment applications are submitted for Medicare and Medicaid programs. + Minimize deactivation of government applications by following quality control procedures. + Contact Providers when Revalidation notices are received in order to obtain signature pages and validate current general information. + Receive escalated claim issues from other internal departments and coordinate contact with payer to develop solutions and when brought to resolution; communicate to others internally as appropriate. + Update Credentialing and Billing systems with Provider information upon inquiry or receipt from payers. + Create content for state summary, policy and procedures, maintain existing training modules. + Research potential issues, develop solutions and bring to resolution. + Send communication/updates to the field as needed. 10% + Research and analyze trends ( i.e. claims, providers, clinics) in order to make recommendations for process improvements and system efficiencies + Keep an issue log with all provider payer issues for your states each week. + Work with SPM and CPMs to ensure that all providers are enrolled in the correct locations, report on all discrepancies and plan for process improvements. + Review all Claims on manager hold/hold i.e. trends, errors, enrollment in new locations, correct ins. + Pkg. review non-billable services, etc. + Ensure all enrollments and specific data is maintained timely and accurately in the tracking system so all information can be easily referenced. + Identify and improve tracking system for efficiency. + 5% for mid-level and senior executives Requirements: + High school diploma or GED required, Bachelors Degree in Business Administration, Marketing, Finance or similar field preferred and have 2+ years of relevant work experience. + 2 years of overall provider enrollment related experience of Center for Medicare/Medicaid Services (CMS) guidelines for Medicare Part B enrollment processes or previous work experience in regulatory environment Why Should You Apply? + Health Benefits + Referral Program + Excellent growth and advancement opportunities As an equal opportunity employer, ICONMA provides an employment environment that supports and encourages the abilities of all persons without regard to race, color, religion, gender, sexual orientation, gender identity or express, ethnicity, national origin, age, disability status, political affiliation, genetics, marital status, protected veteran status, or any other characteristic protected by federal, state, or local laws.