The Provider Enrollment Specialist has primary responsibility for oversight and maintenance of the professional provider enrollment process and CCHCS software system master files serving 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 CCHCS 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 Provider 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.
Proficiency with Microsoft (Word, Excel, Access and PowerPoint) applications required.
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.
Licensure, Registration, and/or Certification
Certification as a Certified Provider Credentialing Specialist (CPCS), preferred.
Internal Number: 50424-42960
About Cook Children's Health Care System
Cook Children's Health Care System embraces an inspiring Promise – to improve the health of every child in our region through the prevention and treatment of illness, disease and injury. Based in Fort Worth, Texas, we’re proud of our long and rich tradition of serving our community.