Sr Provider Services Specialist- Provider Enrollment

Location: Texas Medical Center-Houston, Texas

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Category: Healthcare Support Services

McGovern Medical School at UTHealth Houston

Requisition #: 240002C0

What we do here changes the world. UTHealth Houston is Texas’ resource for healthcare education, innovation, scientific discovery, and excellence in patient care. That’s where you come in.

Once you join us you wont want to leave. It’s because we reward our team for the excellent service they provide. Our total rewards package includes the benefits you’d expect from a top healthcare organization (benefits, insurance, etc.), plus:

• 100% paid medical premiums for our full-time employees

• Generous time off (holidays, preventative leave day, both vacation and sick time – all of which equates to around 37-38 days per year)

• The longer you stay, the more vacation you’ll accrue!

• Longevity Pay (Monthly payments after two years of service)

• Build your future with our awesome retirement/pension plan!

We take care of our employees! As a world-renowned institution, our employees’ wellbeing is important to us. We offer work/life services such as...

• Free financial and legal counseling

• Free mental health counseling services

• Gym membership discounts and access to wellness programs

• Other employee discounts including entertainment, car rentals, cell phones, etc.

• Resources for child and elder care

• Plus many more!

Position Summary:

The Sr Provider Services Specialist is responsible for the preparation and timely processing of provider enrollment applications and their maintenance in accordance with state and federal Centers for Medicare and Medicaid Services (CMS) regulations. This role is also responsible for training Provider Enrollment staff and University departmental contacts on enrollment processes.

Position Key Accountabilities:

Essential Functions

• Prepares and processes applications for initial Medicaid enrollment including data entry into various systems (Service Now, ECHO, etc.) for all departments across the University.

• Processes Blue Cross/ Blue Shield and Railroad Medicare applications for all billing providers.

• Completes Medicare/Medicaid revalidations for all billing providers.

• Trains junior provider services specialist staff and departmental credentialing coordinators on departmental functions.

• Conducts internal audits on provider files - Ensure provider file is completed, from start to finish.

• Works with revenue cycle liaison to ensure all Medicaid/Medicare issues have been addressed and resolved.

• Ensures escalation to senior leadership on expired licensure, taxonomy issues, NPPES issues to all departments for billing providers.

• Runs reports on Medicare opt-out and sends to Credentialing team for preparation of monthly Credentialing meeting.

• Performs other duties as assigned.

Certification/Skills:

• Thorough knowledge of MS Office applications (MS Word, Excel, Power point)

• Exceptional organizational and multi-tasking abilities as well as the ability to work in a fast paced, action-oriented environment

• Ability to perform detailed work with a high degree of accuracy

• Knowledge and understanding of Credentialing databases and systems

Minimum Education:

Associate's Degree preferred

Minimum Experience:

3 years experience in Medicare/Medicaid enrollment required Training experience in credentialing or Medicare/Medicaid enrollment preferred

Physical Requirements:

Exerts up to 20 pounds of force occasionally and/or up to 10 pounds frequently and/or a negligible amount constantly to move objects.

Security Sensitive:

Security Sensitive: This job class may contain positions that are security sensitive and thereby subject to the provisions of Texas Education Code § 51.215

Residency Requirement:

Employees must permanently reside and work in the State of Texas.

If you are looking for a great healthcare career in Houston, visithttp://go.uth.edu/careers!

University of Texas Health Science Center at Houston (UTHealth)

Established in 1972 by The University of Texas System Board of Regents, The University of Texas Health Science Center at Houston (UTHealth) is Houston’s Health University and Texas’ resource for health care education, innovation, scientific discovery and excellence in patient care. The most comprehensive academic health center in the UT System and the U.S. Gulf Coast region, UTHealth Houston is home to schools of biomedical informatics, biomedical sciences, dentistry, nursing and public health and the John P. and Kathrine G. McGovern Medical School. UTHealth Houston includes The University of Texas Harris County Psychiatric Center, as well as the growing clinical practices UT Physicians, UT Dentists and UT Health Services. The university’s primary teaching hospitals are Memorial Hermann-Texas Medical Center, Children’s Memorial Hermann Hospital and Harris Health Lyndon B. Johnson Hospital.

UTHealth Benefits

UTHealth Houston offers a comprehensive and competitive benefits package. For more information on our benefits programs please refer to the UTHealth Houston Office of Benefits Website.

https://www.uth.edu/benefits/

Equal Employment Opportunity Statement

UTHealth Houston is committed to providing equal opportunity in all employment-related activities without regard to race, color, religion, sex, sexual orientation, national origin, age, disability, genetic information, gender identity or expression, veteran status or any other basis prohibited by law or university policy. Reasonable accommodation, based on disability or religious observances, will be considered in accordance with applicable law and UTHealth Houston policy. The University maintains affirmative action programs with respect to women, minorities, individuals with disabilities, and eligible veterans in accordance with applicable law.

UTHealthHoustonhas adopted a policy consistent with CMS regulations to protect our patients and university community from exposure to COVID-19. This policy affects all employees, residents, fellows, students, contractors, new hires, visiting scholars program participants, adjunct faculty, and volunteers who work, train, or collaborate at the John S. Dunn Behavioral Science Center.

In addition, all UTHealthHouston​​​​​​​employees who are assigned to work at a location that is subject to the affiliated partner’s hospital, clinical offices, or agency are required to abide by UTHealth’sHoustonrules and regulations, as well as the affiliate’s rules and regulations, including COVID-19 vaccination and safety requirements.

Work location is based on the needs of the department and may be adjusted.