Summary: The PN Provider Enrollment Specialist has primary responsibility for oversight and maintenance of the professional provider enrollment process and CCPN software system master files serving CCPN employed physicians. Additionally, the duties include establishing, maintaining, and constantly reviewing the accuracy of Medicare, Texas Medicaid, CSHCN, Texas Health Steps, Out-of-State Medicaid, and Blue Cross/Blue Shield Provider Billing Numbers for CCPN employed providers and EP1(Texas Health Steps) numbers for primary care locations, completing attestations through Texas Medicaid, completing portions of TMHP audits and disposition of claims in workqueue pending effective dates from payers. The Revenue Cycle Enrollment Specialist provides support to clinical and Revenue Cycle areas for all matters involving provider demographics, service location, licensure or taxonomy designation. They ensure timely submission of all payor-specific forms and documentation to health plans including license updates and malpractice insurance information; maintenance and communication of provider changes, corrections, and terminations in various databases and master files. Responds to any deficiency notifications on behalf of the provider. Attain, verify, and disseminate state required billing numbers and approval letters as needed.
High School diploma or equivalent required.
Requires a minimum of five years' experience within the medical practice management field with emphasis on provider eligibility, enrollment and participation.
Extensive knowledge and experience in physician billing, with particular demonstrated expertise in Medicare and Medicaid guidelines required.
Must demonstrate detailed knowledge of the professional enrollment process.
Career accomplishments must demonstrate a capacity to work continuously at a highly detailed level and the ability to meticulously follow-up on and document work assignments.
Candidate must demonstrate a high level of desire for completeness, accuracy and critical thinking.
Proficiency with Microsoft (Word, Excel, Access and PowerPoint) applications required.
Licensure, Registration, and/or Certification
Certification as a Certified Provider Credentialing Specialist (CPCS), preferred.
Internal Number: 40568
About Cook Children's Medical Center
Cook Children's Health Care System is a not-for-profit, nationally recognized pediatric health care organization comprised of eight entities – a Medical Center, Physician Network, Home Health company, Northeast Hospital, Pediatric Surgery Center, Health Plan, Health Services Inc., and Health Foundation.Cook Children's Medical Center Based in Fort Worth, Texas, the integrated system has more than 60 primary and specialty care offices throughout North Texas. Its service region includes Denton, Hood, Johnson, Parker, Tarrant and Wise counties, with an additional referral area encompassing nearly half the state.Cook Children's traces its roots back to 1918, but throughout its continual change and robust growth, it still embraces an inspiring promise – to improve the health of every child in its region through the prevention and treatment of illness, disease and injury. To live up to this promise, Cook Children's combines the art of caring with the use of leading technology and extraordinary collaboration to provide exceptional care for every child, every day.History – Cook Children's has a rich history of nearly a century of caring for children.Our Promise – Knowing that every child's ...life is sacred, it is the promise of Cook Children's to improve the health of every child in our region through the prevention and treatment of illness, disease and injury.Companies – Based in Fort Worth, Texas, Cook Children's is a not-for-profit organization that is comprised of eight nationally recognized companies.Community Health Outreach – Cook Children's Community Health Outreach works together with over 150 partner organizations to improve the safety and health of at-risk children through education, disease and injury prevention and support.Clinical Research – Cook Children's is home to a skilled team of research-minded physicians, nurses and health care professionals and administrators who drive our commitment to excellent clinical care and the search for medical advances.Public Relations – Cook Children's Public Relations works with national and local media outlets, produces Cook Children's publications, coordinates special events and helps develop key relationships within the community.Contractor & Vendor Information – Cook Children's contractors and vendors must ensure their employees are knowledgeable about working with our organization.Sponsorship guidelines – Cook Children's sponsors a select number of events that are strongly aligned with its promise to improve the health of every child in the region through the prevention and treatment of illness, disease and injury.