This position will assist UPG and UVA Community Health Medical Group (UVACHMG) in complying with all UPG and UVACHMG delegated credentialing and enrollment processes to maintain provider eligibility to bill Medicare/ Medicaid/ Department of Defense and managed care payors for the provision of professional health care services. Such functions include enrollment of all new physicians with government and managed care payors. In addition, this position will work with UPG HR to ensure employment agre... more details
This position will assist UPG and UVA Community Health Medical Group (UVACHMG) in complying with all UPG and UVACHMG delegated credentialing and enrollment processes to maintain provider eligibility to bill Medicare/Medicaid/Department of Defense and managed care payors for the provision of professional health care services. Such functions include enrollment of all new physicians with government and managed care payors. In addition, this position will work with UPG HR to ensure employment agreements are renewed timely in an effort to eliminate delays with professional billing.
- Handles enrollment information for Medicare and Medicaid to ensure the highest level of accuracy.
- Completes enrollment process including provider enrollment activities by completing applications for all Medicare and Medicaid, including tracking of such applications until the provider numbers are issued.
- Works with Insurance Processing Unit departments in Billing and Collections by working Departmental requests on provider issue denials.
- Works with payors on changes, such as address changes to both physical location and payment address, name changes, etc.
- Responsible for creation of Professional Billing Spreadsheet and forwards to EPIC PB Team of all new physicians and allied health professionals being issued privileges, as well as changes to existing physicians/allied health professionals entry providers once privileges are issued/changed or terminated. Authorizes any updates to the provider professional billing record in EPIC.
- Coordinates leased professional providers in collaboration with UPG Legal, UVAHR and UVA Clinical Staff Office to allow for timely enrollment in all health care plans with the UPG UVACHMG contracts, to enable UPG UVACHMG to bill and collect professional services on their behalf.
- Approves all entries to the provider professional billing record in EPIC.
- Collaborates with UPG IPU on provider related claim denials and acts as liaison between payor and UPG until resolve and claim reprocessed and paid.
- Assists with payor transparency by communicating to payor any discrepancies between payor and the UPGUVACHMG enrollment information.
- Responsible for reaching out to physicians and allied health professionals directly to obtain access via the CMS PECOS portal to obtain access to act on their behalf for Medicare enrollment and NPI updates via the NPPES portal.
- Responsible for updating and entry of all physician and allied health professional credentialing information into the Symplr provider database shared with the CSO to include practice address information.
- Assist with projects related to new practice locations for UPG and UVACHMG, to include relocation and changes for such. Including working with project manager on EPIC information, updating of Symplr, notification of new location, change, etc. to Medicare/Medicaid/Department of Defense and managed care companies.
- Maintains confidentiality of credentialing and enrollment information
- Provides backup coverage to the others on the enrollment team.
- In addition to above job responsibilities, other duties may be assigned.
Position Compensation Range: $52,436.80 - $83,907.20 Annual
MINIMUM REQUIREMENTS
Education: High school graduate or equivalent required. Bachelors Degree Preferred.
Experience: 5 years’ prior experience in a healthcare environment. Experience working accurately under time pressures Experience anticipating end users’ problems.
Licensure: None.
Skills: Intermediate knowledge of and experience utilizing a personal computer Intermediate word processing and spreadsheet skills. Basic knowledge of database software or willingness to attain such within 6 months of hire.
PHYSICAL DEMANDS
This is primarily a sedentary job involving extensive use of desktop computers. The job does occasionally require traveling some distance to attend meetings, and programs.
The University of Virginia, including the UVA Health System which represents the UVA Medical Center, Schools of Medicine and Nursing, UVA Physician’s Group and the Claude Moore Health Sciences Library, are fundamentally committed to the diversity of our faculty and staff. We believe diversity is excellence expressing itself through every person's perspectives and lived experiences. We are equal opportunity and affirmative action employers. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex, pregnancy, sexual orientation, veteran or military status, and family medical or genetic information.
