Provider Enrollment Specialist (Finance)

Nemours is seeking a Provider Enrollment Specialist in Jacksonville, FL.

Primary Function:

Individuals in this role interact with Nemours internal and external stakeholders to perform Enrollment and Re-Enrollment of our organization and its healthcare professionals. This individual will:

Possess accuracy and attention to detail in administrative and technical duties.

Follow the enrollment processes for all managed care networks and government payors that the organization is contracted with, or has an agreement with, for the reimbursement of services.

Have continuous contact with internal and external customers, including physicians and other healthcare providers, administrators, support staff and network representatives.

This individual is responsible for communicating provider participation information to stated internal and external customers through established processes to allow for appropriate patient scheduling and reimbursement for services rendered.

Essential Functions:

Accurately complete the enrollment/ re-enrollment processes as outlined by each network/area for all appropriate healthcare providers. These will be identified through department policies, network reimbursement and delegated contracts to ensure timely and continued provider network participation.

Maintain detailed provider enrollment files in electronic format, including electronically received documents and scanned hardcopy documents, while appropriately following each stage of the enrollment/re-enrollment process thoroughly and respecting Nemours process for PHI.

Accurately maintain all internal systems with the appropriate provider and network participation information. Systems including, but not limited to, ECHO, Excel, PET Tracker, iGuide, Qliksense, the NPL tracker, internet, Outlook, and word processing.

Performs follow up with health plans and their representatives to expedite participation approval by each health plan.

Develop and maintain good working relationships with Nemours providers and support staff to obtain necessary and timely information and to facilitate the provider enrollment/re-enrollment process.

Develop and maintain relationships with Network Representatives to facilitate the provider enrollment/re-enrollment processes and maintain accurate data in the plan directories.

Responsible for sending enrollment applications to providers, as appropriate, to maintain signatures and demographic information.

Work collaboratively with fellow team members to create, evaluate and maintain department workflows, processes, policies, and systems. Additionally, each team member is expected to cross train on plan requirements to assist one (or more) other team member(s) in completing assigned duties.

Will assist with special priority projects and other miscellaneous duties and responsibilities, as assigned by employee's supervisor or department leadership.

Requirements:

Associate Degree Required

Equivalent work experience in the field of provider enrollment or acceptable field as determined by department leadership will also be considered.

About Us

Nemours Children's Health is an internationally recognized children's health system. With more than 1.7 million patient encounters annually, we provide medical care in five states through two freestanding state-of-the-art children's hospitals - Nemours Children's Hospital, Delaware and Nemours Children's Hospital, Florida. Our pediatric network includes 80 primary-urgent-and specialty care practices and more than 40 hospitalists serving 19 affiliated hospitals. We generate annual revenues of more than $1.7 billion derived from patient services, contributions from the Alfred I. DuPont Trust, as well as other income.

As one of the nation's premier pediatric health systems, we're on a journey to discover better ways of approaching children's health. Putting as much focus on prevention as cures and working hand in hand with the community to make every child's world a place to thrive. It's a journey that extends beyond our nationally recognized clinical treatment to an entire integrated spectrum of research, advocacy, education, and prevention, leading to the healthiest generations of children ever.

Inclusion and belonging guide our growth and strategy. We are looking for individuals who are passionate about, and committed to, leading efforts to provide culturally relevant care, reducing health disparities, and helping build an inclusive and supportive environment. All of our associates are expected to ensure that these philosophies are embedded in their day-to-day work with colleagues, patients and families.

To learn more about Nemours Children's and how we go well beyond medicine, visit us at www.nemours.org .