RCM Certification and Enrollment Specialist

PURPOSE AND SCOPE:

This position is responsible for:

• State Medicaid application process

• Medicare EDI enrollment.  

• ERA, EFT, Claims Enrollment

• DDE and payer website access

• Applications for specific non-network payors

• Functions as a centralized group to best serve the Business for all enrollment needs. Provide visibility to the organization on the status of facilities during the enrollment processes. Cultivate and maintain a professional relationship with industry partners.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

• • Follow Acquisition, Joint Venture and DeNovo facility from rumor to completion (point of billing)

  • Participate in the acquisition, JV conversion and new facility calls

  • Assists Regulatory with CMS 855 application issues & follow up

  • Track completion of state license and CLIA

  • Monitor for expiration of state licenses and provide current documents to State Medicaid

  • EDI Enrollment with Medicare Administrative Contractor (MAC)

  • Facility setup for Electronic Claims in Relay Health

  • Establish connection with Corporate DSD EDI

  • Add PTAN's to MDE transmission via Relay Health

  • Complete Medicaid applications to include all required facility documents and managing employee Medicaid Disclosure Questionnaire's (MDQ). Work with internal Regulatory and Legal teams to ensure all disclosure information is current and accurate

  • Document management - KIMA/ExtraView and the EDS Team SharePoint site

  • Medicaid Re-credentialing

  • Medicare PTAN, Medicaid provider #, and location addresses updates in Facility Database

  • Facility relocation reporting to state Medicaid programs

  • Revenue Center assignment in Big Wave system

  • Medicare DDE enrollment and recertifications

  • Establish/terminate Revenue Centers and Cash Departments access to all insurance payer websites

  • Commercial payer enrollment for EFT, ERA and electronic claims

  • Reenroll commercial payors for ERA, EFT, Claims

  • Tricare applications for non-network participation

  • Blue Cross Blue Shield applications for out of network provider numbers.

  • Create and maintain all W9's

  • Other duties as assigned

     

     

Additional responsibilities may include focus on one or more departments or locations. See applicable addendum for department or location specific functions.

PHYSICAL DEMANDS AND WORKING CONDITIONS:

• The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION:

• High School Diploma

EXPERIENCE AND REQUIRED SKILLS:

• Minimum 1 year experience in medical accounts receivable

• Strong time management skills and the ability to juggle multiple tasks

• High level of creativity, innovation, initiative, and sense of ownership

• Organizational capabilities and strong attention to detail

• Self-motivated, quick learner and independent thinker

• Must be able to work well independently, and in a team environment

• Must be capable of quickly identifying issues and provide recommendations

• Excellent verbal/written and communication skills

• Proficient in MS Excel

• Protect highly sensitive and confidential information

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.