[Hiring] Provider & Facility Enrollment Specialist @Inland RCM
Role Description
Join the team that delivers a Healthier Bottom Line. Our purpose at InlandRCM is to strengthen rural hospitals by providing dependable, all-American revenue cycle expertise that sustains access to quality healthcare in rural communities. Hours are 8am-5pm PST Monday-Friday. THIS IS A REMOTE POSITION.
We are seeking a skilled Provider & Facility Enrollment Specialist to join our growing team and play a key role in supporting new client partnerships and the expansion of essential revenue cycle services for rural healthcare organizations.
• Responsible for managing the full lifecycle of provider and facility enrollment with commercial, government, and managed care insurance payers.
• Ensures that all practitioners and facilities are properly credentialed and enrolled to receive reimbursement for rendered services.
• Performs primary source verification (PSV) functions to support the credentialing process in accordance with regulatory standards, accreditation requirements, and organizational policies.
• Plays a critical role within the revenue cycle workflow, directly impacting the organization's ability to bill and collect for services in a timely and compliant manner.
Qualifications
• High School Diploma/GED required.
• Two-year medical billing course is desired.
• Minimum 2-3 years of experience in provider enrollment, credentialing or a related healthcare revenue cycle role required.
• Experience working with Medicare (PECOS), Medicaid, and commercial payer enrollment processes required.
• Experience performing primary source verification in a credentialing or managed care environment preferred.
• Experience with a multi-specialty or multi-facility provider environment preferred.
• Certifications:
• Certified Provider Credentialing Specialist (CPCS) - National Association Medical Staff Services (NAMSS)
• Certified Professional in Medical Staff Management (CPMSM) - NAMSS
• Certified Revenue Cycle Representative (CRCR) - HFMA
• Experience with Microsoft Office products (Outlook, Word, Excel); Workday, Internet, Intranet, Meditech, Heathland, Techtime, EMDs, Epic or other hospital or physician accounting system is highly desired.
Requirements
• Initiates, completes, and submits enrollment applications for individual providers and facilities with Medicare, Medicaid, and commercial insurance payers via paper and electronic methods (PECOS, CAQH, payer portals).
• Manages the re-enrollment, revalidation, and maintenance of existing provider records to ensure continuous billing privileges.
• Coordinates with providers, practice administrators, and facility leadership to obtain required documentation, signatures, and information necessary to complete enrollment applications.
• Tracks and monitors enrollment application status through completion, resolving payer inquiries and deficiencies in a timely manner.
• Maintains accurate and up-to-date records of all enrollment activity within the enrollment tracking system.
• Processes provider demographic changes with all applicable payers.
• Collaborates with billing, contracting, and credentialing teams to ensure alignment of enrollment data and prevent billing denials.
• Researches and resolves enrollment-related claim denials and payment delays in coordination with the billing department.
• Maintains knowledge of Medicare, Medicaid, and commercial payer enrollment regulations, policies, and procedures.
• Conducts primary source verification of provider credentials in compliance with accreditation standards.
• Documents all PSV activities within the credentialing database or provider credentialing file.
• Flags and escalates discrepancies, sanctions, exclusions, or adverse findings identified during the verification process.
• Monitors expirable credentials and initiates re-verification processes in advance of expiration dates.
• Ensures PSV processes comply with organizational policies and regulatory requirements.
• Maintains organized and audit-ready enrollment and credentialing files for all providers and facilities.
• Participates in payer audits, internal audits, and accreditation surveys as required.
• Generates and distributes enrollment status reports and metrics to management on a regular basis.
• Stays current on changes to payer enrollment requirements, CMS regulations, and credentialing standards through ongoing education and training.
• Assists with onboarding new provider clients, including education on enrollment timelines and requirements.
• Performs other duties as assigned by management in support of revenue cycle operations.
Benefits
• Ability to work from a remote location (home).
• Required to have a dedicated area to perform the job, that is private and has a desk, chair, appropriate lighting, and access to internet.
Apply tot his job
Apply To this Job
Join the team that delivers a Healthier Bottom Line. Our purpose at InlandRCM is to strengthen rural hospitals by providing dependable, all-American revenue cycle expertise that sustains access to quality healthcare in rural communities. Hours are 8am-5pm PST Monday-Friday. THIS IS A REMOTE POSITION.
We are seeking a skilled Provider & Facility Enrollment Specialist to join our growing team and play a key role in supporting new client partnerships and the expansion of essential revenue cycle services for rural healthcare organizations.
• Responsible for managing the full lifecycle of provider and facility enrollment with commercial, government, and managed care insurance payers.
• Ensures that all practitioners and facilities are properly credentialed and enrolled to receive reimbursement for rendered services.
• Performs primary source verification (PSV) functions to support the credentialing process in accordance with regulatory standards, accreditation requirements, and organizational policies.
• Plays a critical role within the revenue cycle workflow, directly impacting the organization's ability to bill and collect for services in a timely and compliant manner.
Qualifications
• High School Diploma/GED required.
• Two-year medical billing course is desired.
• Minimum 2-3 years of experience in provider enrollment, credentialing or a related healthcare revenue cycle role required.
• Experience working with Medicare (PECOS), Medicaid, and commercial payer enrollment processes required.
• Experience performing primary source verification in a credentialing or managed care environment preferred.
• Experience with a multi-specialty or multi-facility provider environment preferred.
• Certifications:
• Certified Provider Credentialing Specialist (CPCS) - National Association Medical Staff Services (NAMSS)
• Certified Professional in Medical Staff Management (CPMSM) - NAMSS
• Certified Revenue Cycle Representative (CRCR) - HFMA
• Experience with Microsoft Office products (Outlook, Word, Excel); Workday, Internet, Intranet, Meditech, Heathland, Techtime, EMDs, Epic or other hospital or physician accounting system is highly desired.
Requirements
• Initiates, completes, and submits enrollment applications for individual providers and facilities with Medicare, Medicaid, and commercial insurance payers via paper and electronic methods (PECOS, CAQH, payer portals).
• Manages the re-enrollment, revalidation, and maintenance of existing provider records to ensure continuous billing privileges.
• Coordinates with providers, practice administrators, and facility leadership to obtain required documentation, signatures, and information necessary to complete enrollment applications.
• Tracks and monitors enrollment application status through completion, resolving payer inquiries and deficiencies in a timely manner.
• Maintains accurate and up-to-date records of all enrollment activity within the enrollment tracking system.
• Processes provider demographic changes with all applicable payers.
• Collaborates with billing, contracting, and credentialing teams to ensure alignment of enrollment data and prevent billing denials.
• Researches and resolves enrollment-related claim denials and payment delays in coordination with the billing department.
• Maintains knowledge of Medicare, Medicaid, and commercial payer enrollment regulations, policies, and procedures.
• Conducts primary source verification of provider credentials in compliance with accreditation standards.
• Documents all PSV activities within the credentialing database or provider credentialing file.
• Flags and escalates discrepancies, sanctions, exclusions, or adverse findings identified during the verification process.
• Monitors expirable credentials and initiates re-verification processes in advance of expiration dates.
• Ensures PSV processes comply with organizational policies and regulatory requirements.
• Maintains organized and audit-ready enrollment and credentialing files for all providers and facilities.
• Participates in payer audits, internal audits, and accreditation surveys as required.
• Generates and distributes enrollment status reports and metrics to management on a regular basis.
• Stays current on changes to payer enrollment requirements, CMS regulations, and credentialing standards through ongoing education and training.
• Assists with onboarding new provider clients, including education on enrollment timelines and requirements.
• Performs other duties as assigned by management in support of revenue cycle operations.
Benefits
• Ability to work from a remote location (home).
• Required to have a dedicated area to perform the job, that is private and has a desk, chair, appropriate lighting, and access to internet.
Apply tot his job
Apply To this Job