Job Description

AltaPointe Health Systems is a comprehensive behavioral healthcare and psychiatric hospital system. Our continuum of care includes two psychiatric hospitals, multiple behavioral health, and primary care outpatient locations, and residential services. This position is responsible for managing the enrollment and re-enrollment application process for all AltaPointe Health System providers with all applicable commercial, federal, and state payer plans.

Responsibilities

Oversees the production capability of the provider enrollment department

• Plan and control effective practices to ensure that all providers are enrolled accurately with applicable payers in a timely manner
• Implement and monitor compliance with all revenue cycle and departmental specific policies and procedures, ensuring maximum effectiveness
• Respond to third-party inquiries/complaints and determine and initiate appropriate action
• Ensure staff is productive by tracking productivity measures

Actively participate in all functions relating to the administrative work in coordinating the enrollment and re-enrollment process of providers with the Alabama Department of Mental Health, Medicaid, Medicare, and other third-party payers

• Ensure accurate enrollment applications for new providers are completed in a timely manner.
• Maintain accurate information with regards to the re-enrollment standards for all payers.
• Ensure re-enrollment applications are submitted in a timely manner to ensure that providers are up to date with their re-enrollment status.
• Follow up with the contractual insurance carriers regarding provider/facility enrollment/termination/relocation status.
• Enroll all providers in CAQH and provide re-attestations as needed

Maintains the Provider Enrollment Database

• Issues monthly reports from the the database to ensure proper communication regarding provider status related to enrollment
• Provides additional status reports and updates as needed.
• Updates the appropriate provider enrollment matrix.
• Tracks progress of outstanding applications and inform the appropriate parties of in-network effective

Communicates and Coordinates efforts with outside billing companies and the AltaPointe billing department to ensure billing denials due to enrollment issues are addressed in a timely manner.

• Communicates with internal management, providers, and departments in regards to the enrollment process
• Proactively communicates with Human Resources in regards to the needs/requirements of the enrollment department as it relates to provider
• Works closely with providers to obtain the necessary
• Assists providers in obtaining/updating an NPI number.

Coordinate and communicate with the billing department

• Collaborates with the billing department to resolve any provider based denial issues related to the enrollment process.
• Communicates with appropriate billing staff regarding the status of a provider’s enrollment with individual payers. Any significant delays must be reported to management
• Assists with the maintenance of the Practitioner Enrollment forms in Avatar in a timely manner.

Courteous and respectful towards consumers, visitors, and co-workers

• Treat consumers with care, dignity, and compassion
• Respect consumers’ privacy and confidentiality
• Is pleasant and cooperative with others
• Assist consumers and visitors as needed
• Personal values don’t inhibit the ability to relate and care for others
• Is sensitive to the consumer’s needs, expectations, and individual differences
• Is gentle and calm with consumers, families, and others as appropriate

Administrative and Other Related Duties as assigned:

• Actively participate in Performance Improvement activities
• Actively participate in AHS committees as requested
• Complete assigned tasks in a timely manner
• Follow AHS policies and procedures
• Receive and respond to inquiries of billing matters promptly and courteously.
• Assist with performance of duties of other staff in periods of absence.
• Perform other duties as assigned.

Qualifications

Bachelor’s degree in business or related field along with three years of related experience. Applicant must have a working knowledge of MS Office: Excel, Word, etc. Applicant must have excellent verbal and written communication skills. Proficiency in database management is plus. Proven supervisory skills, excellent organizational skills and attention to detail required.