Enrollment & Billing Director oversees one or more departments responsible for enrollment and billing operations for an insurance company. Ensures information accuracy and customer satisfaction. Being an Enrollment & Billing Director establishes and implements organizational policies. May offer guidance on appropriate handling of complex or high-value accounts. Additionally, Enrollment & Billing Director typically requires a bachelor's degree. Typically reports to top management. The Enrollment & Billing Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. To be an Enrollment & Billing Director typically requires 5+ years of managerial experience. (Copyright 2024 Salary.com)
Qualifications
Bachelor’s Degree in Business Administration or a human services related field with a strong working knowledge of state and federal regulations, Medicaid billing, managed care/prior authorizations, credentialing/licensing requirements, and an understanding of basic finance and/or accounting principles, with 3-5 years’ experience.
Proficient in Microsoft Office (Word & Excel) or similar software.
Must be a motivated individual with a positive and exceptional work ethic.
Ability to work independently with strong time management skills including planning, organization, multi-tasking, and ability to prioritize as required.
Highly organized, proficient in tracking deadlines and target dates
Strong attention to detail and accuracy
Must demonstrate effective communication skills both verbally and written.
Job Duties:
Gather credentials and re-credentialing materials for contracted and full-time clinicians.
Review and analyze clinician applications and reapplications, and accompanying documents, ensuring clinician eligibility.
Processes clinician accreditation, managed care, governmental and commercial insurance enrollment and re-credentialing.
Responsible for daily provider data management and review of credentialing files for accuracy and completeness, utilizing internal and external sources.
Perform primary source verification via various state and national sources.
Maintain individual provider credential files with all the appropriate documentation consistent with AAAHC and NCQA standards.
Oversee, update and maintain provider credential database such as CAQH, PECOS, NPPES Registry, or other applicable regulatory agencies.
Responds timely to provider inquiries by letter, phone, fax, secure email or internal communication.
Work closely and maintain relationships with provider relations at each payer and communicate any challenges and/or concerns with management.
Develop and prepare analytical reports as needed to analyze compliance, enrollment trends, clinician standings, contract dates etc.
Identify and resolve credentialing issues through reporting.
Review, and update, if necessary, health plan directories, agencies, and other appropriate entities for current and accurate provider information.
Additional duties as assigned.
Job Type: Full-time
Pay: $51,542.00 - $59,758.00 per year
Benefits:
Schedule:
Work Location: In person
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