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Description

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**Summary** : The System Provider Enrollment Specialist is responsible for the coordination and tracking process of managed care enrollment.

**Responsibilities** :

1. Individual Provider and Group Enrollment - Responsible for application management, completion and submission of a variety of forms and supporting documentation that allows the health system and individual providers to participate in Medicare and Medicaid plans. Maintains thorough knowledge and understanding of the various plans and how to organize and submit the supporting documentation required for each enrollment process. Follows an efficient process to ensure an accurate and efficient enrollment.

2. Manages Provider SER Table – Manages the health system’s Provider databases and uses judgment, internal guidelines, and CMS and HIPAA regulations to determine the way in which providers are added and maintained in these data bases.

3. Monitors, researches and resolves suspended and denied charges - Monitors and resolves charges which are suspended due to missing provider data, and/or have denied due to lack of pertinent provider data. Maintains thorough knowledge of the UNC Healthcare billing system, UNC Healthcare GE system, carrier rules, clinical department guidelines, and HIPAA regulations. Identifies the cause of the suspended or denied charges and determines the appropriate steps required to resolve them.

4. Policy Analysis, Communication and Advocacy - Interprets, explains, and follows the regulatory guidelines of government payer plans and keeps abreast of constantly changing payer policies, systems, and processes. Communicates clearly, professionally, and concisely with a diverse group of stakeholders across the health care system to ensure all necessary steps are taken to remain compliant with changes. Establishes and maintains on-going relationships with internal and external stakeholders to ensure effective participation status in payer programs.

5. Collaboration – Collaborates with the clinical departments, UNC Physicians Revenue Cycle Management contacts, Office of Medical Staff Services at UNC hospitals and other affiliate entities to obtain and validate pertinent provider data.

Other Information

Other information:

Education Requirements:

• High School diploma or GED

Licensure/Certification Requirements:

• No licensure or certification required.

Professional Experience Requirements:

• Five (5) years of experience relating to healthcare, insurance or customer service.

Knowledge/Skills/and Abilities Requirements:

• Ability to work well in a team environment.

Job Details

Legal Employer: NCHEALTH

Entity: Shared Services

Organization Unit: Provider Enrollment

Work Type: Full Time

Standard Hours Per Week: 40.00

Salary Range: $19.59 - $27.84 per hour (Hiring Range)

Pay offers are determined by experience and internal equity

Work Assignment Type: Remote

Work Schedule: Day Job

Location of Job: US:NC:Morrisville

Exempt From Overtime: Exempt: No

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Heath Care System. This is not a State employed position.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [email protected] if you need a reasonable accommodation to search and/or to apply for a career opportunity.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.