Business & Provider Enrollment Coordinator

Description

Reporting/Department Head:
Claudia Villalpando (Finance)

* FLSA Status – Non-Exempt

* EEO Category – Administrative

Our Mission: “To improve lives by providing comprehensive, high-quality healthcare to every person in every community that we serve.”

Our Vision: CCHN will maintain its position as the leading community health center in the state and become a model for all other healthcare organizations to follow.

Responsible for coordinating, monitoring, and maintaining the insurance enrollment and re‑enrollment process for providers and electronic billing. Ensure that file maintenance within the practice management system is kept up to date for billing purposes. Establish and maintain a relationship with outside vendors/contractors pertaining to medical billing and provider enrollment needs.

• Ensure all new providers are enrolled with every major carrier within 6 months of hire
• Medicaid-Medicare-Medicaid HMOs (HNJH, UHCCP, Amerigroup…) –BCBS-Aetna-
• Ameri Health – Ameri Health Administrators – Qualcare – Tri Care – Cigna – Oxford – United Health Care  Commercial, and third‑party plans (Davis, Magellan…)
• Ensure all CCHN locations are attached to all major payers
• Maintain grid of provider’s status with payers
• Obtain and maintain CAQH and NPI provider and location profiles
• Maintain/Update file maintenance as it pertains to billing
• Providers
• Locations
• Insurance Contracts
• Encounter Rates
• Add New Insurances
• Add CPTs and ICD
  10 (as needed)
• Establish and maintain a relationship with outside vendors/contractors pertaining to medical billing and provider enrollment needs.
• Establish and maintain a relationship with provider relations representatives from payers
• Deposit (as assigned)
• Reconciliation of payments or charges (as assigned)
• Help Business associates with A/R management (as assigned)
• Help with internal and external phone calls
• Miscellaneous duties (special projects assigned as needed)

Complete Care offers full‑time and part‑time employees a variety of generous benefits, including but not limited to:

• Comprehensive medical, dental, and vision insurance
• Paid time off (vacation, sick leave, and holidays)
• 401(k) retirement plan with employer matching
• Incentive program
• Life and disability insurance
• Continuing education and professional development opportunities
• Flexible Spending Accounts (FSA)
• Tuition reimbursement
• Reimbursement for licensure and certifications
• Reimbursement for CPR
• Discounted services
• Employee recognition programs
• Health Reimbursement Arrangement (HRA) via Ameriflex (covers most out‑of‑pocket expenses)
• Pension plan
• Cancer insurance policies
• Employee‑paid life insurance — 2x annual salary, up to $150K (CCHN‑paid benefit)
• AAA membership (discounted rates)
• BJ’s Wholesale Club membership (discounted rates)
• Direct deposit
• Childcare reimbursement program
• Intersite travel reimbursement

The above job description is not to be construed as a complete listing of the assignments that may be given to any employee, nor are such assignments restricted to those precisely listed in the description.

• Associates in Arts (AA) Degree (preferred)
• Knowledge of provider licensing (Lic., DEA, CDS, malpractice Ins.)
• Proficient with Microsoft Office

• Ability to multi‑task in a fast‑paced environment
• Excellent communication skills
• Able to work as a team player as well as independently
• Detail oriented
• Problem solving skills
• Excellent Customer Service
• Ability to travel (if needed)
• Ability to sit for long periods of time
• Flexible

The above job description is not to be construed as a complete listing of the assignments that may be given to any employee, nor are such assignments restricted to those precisely listed in the description.

EOE