Provider Enrollment Specialist

You’ll want to join Billings Clinic for our outstanding quality of care, exciting environment, interesting cases from a vast geography, advanced technology and educational opportunities. We are in the top 1% of hospitals internationally for receiving Magnet® Recognition consecutively since 2006.

And you’ll want to stay at Billings Clinic for the amazing teamwork, caring atmosphere, and a culture that values kindness, safety and courage. This is an incredible place to learn and grow. Billings, Montana, is a friendly, college community in the Rocky Mountains with great schools and abundant family activities. Amazing outdoor recreation is just minutes from home. Four seasons of sunshine!

You can make a difference here.

About Us
Billings Clinic is a community-owned, not-for-profit, Physician-led health system based in Billings with more than 4,700 employees, including over 550 physicians and non-physician providers. Our integrated organization consists of a multi-specialty group practice and a 304-bed hospital. Learn more about Billings Clinic (our organization, history, mission, leadership and regional locations) and how we are recognized nationally for our exceptional quality.

Your Benefits
We provide a comprehensive and competitive benefits package to all permanent full-time employees (minimum of 24 hours/week), including Medical, Dental, Vision, 403(b) Retirement Plan with employer matching, Defined Contribution Pension Plan, Paid Time Off, employee wellness program, and much more.

Magnet: Commitment to Nursing Excellence
Billings Clinic is proud to be recognized for nursing excellence as a Magnet®-designated organization, joining only 97 other organizations worldwide that have achieved this honor four times. The re-designation process happens every four years.

Pre-Employment Requirements
All new employees must complete several pre-employment requirements prior to starting.

Provider Enrollment Specialist
PAYER RELATIONS (Billings Clinic Main Campus)
req7301

Shift: Day
Employment Status: Full-Time (.75 or greater)
Hours per Pay Period: 1.00 = 80 hours (Non-Exempt)
Starting Wage DOE: $19.16 - 22.51

The Provider Enrollment Specialist is required to work independently with minimal supervision, and is responsible for the accurate and up-to-date enrollment of all health care providers, midlevels, and ancillary providers for Billings Clinic with each of the required third party and/or government insurance payers. Responsibilities include the timely initiation of applications ensuring compliance with all government and payer regulations, timely follow-up of the applications pending, monitoring provider listings with vendors/payers to ensure proper in-network provider listings, and auditing payments/reimbursements to resolve denials. Works closely with the Physician Recruiter, the Medical Staff Office, Human Resources, Payer Relations, Patient Financial Services, Billings Clinic providers and leadership; as well as external payers and regulatory agencies.

Essential Job Functions

• Supports and models behaviors consistent with Billings Clinic’s mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.
• Responsible for enrollment of all Billings Clinic Physicians, midlevels (Physician Assistants and Nurse Practitioners), ancillary providers (i.e., Dietitians, Physical Therapists, Speech Therapists, etc.) and facilities in government insurances such as Medicare, Medicaid, Medicaid Passport and DME for all states where Billings Clinic providers perform services and for all services in all programs which require provider enrollment. Tasks include new provider additions, revisions and terminations, and documentation of all enrollment activities. Ensures reenrollment is accomplished without deactivation/disruption to revenue cycle. Institutes appropriate follow-up and escalation as necessary.
• Responsible for enrollment of all Billings Clinic Physicians, midlevels (Physician Assistants and Nurse Practitioners), ancillary providers (i.e., Dietitians, Physical Therapists, Speech Therapists, etc.) and facilities with all commercial contracted insurance companies. Tasks include new provider additions, revisions and terminations, and documentation of all enrollment activities. Ensures reenrollment is accomplished without deactivation/disruption to revenue cycle. Institutes appropriate follow-up and escalation as necessary.
• Develops and maintains database of all individual provider demographic information for use in enrollment process. Develops and maintains database of all facility demographic information for use in enrollment process. Provides pertinent data to internal and external contacts when appropriate and as needed for audits or other projects.
• Develops and maintains database with contracted insurance company requirements for enrollment, re-enrollment, method of communication, contact information, confirmation, or other criteria, including rules for updates.
• Responsible for audits of insurance carriers’ provider directories annually, or more frequently as needed, to ensure accurate and up-to-date listings are maintained. Coordinates updates with insurance carriers as needed. Develops audit criteria/guidelines on what and when audits will occur. Audits may include provider demographics, specialties in which they are enrolled, and/or plans/contracts in which they are enrolled. Coordinates audits with various vendors annually prior to printing their listing of participating providers to ensure highest level of accuracy and marketing impact to attract new patients.
• Responsible for maintenance of National Provider Identification (NPI) numbers for all Billings Clinic providers and locations requiring separate identification. Proactively obtains up-to-date regulatory requirements. Institutes appropriate follow-up and escalation as necessary. Determines appropriateness of incoming requests for this information and coordinates information with other organizations/providers that may need this information.
• Acts as the liaison between Billings Clinic and vendors who assist with enrollment of Billings Clinic physicians, midlevels and facilities in programs, including out-of-state Medicaid. Responsible for maintaining collaborative relationship, as well as ensuring timely receipt of enrollment notification to avoid timely filing write-offs for care rendered. Institutes appropriate follow-up and escalation as necessary.
• Responsible for ensuring the timely receipt of necessary information from physicians, midlevels and ancillary staff in regard to enrollment needs to assure billing and reimbursement capability in a timely fashion. This includes working directly and independently with clinical operations management, medical staff services, human resources, physician recruitment staff, reserve/temporary staffing department, and physicians, midlevels and ancillary personnel.
• Responds to inquiries from patients, Billings Clinic staff, and outside referring providers as to Billings Clinic provider participation in specific insurance carrier plans.
• Acts as resource to Coding Resources and Patient Financial Services for regulatory compliance with billing and enrollment inquiries.
• Researches and resolves payment denials for enrollment issues in response to patient, payer provider representative, and/or Patient Financial Services inquiries.
• Coordinates and ensures accuracy and timely information from insurance carriers to appropriate personnel within Billings Clinic for entry into the physician masters for billing purposes.
• Serves as subject matter expert for Billings Clinic Payer Relations regarding enrollment requirements. Researches national, regional and local market enrollment trends and requirements. Responsible for learning and applying contract terms. Ensures accurate enrollment, as each market location (i.e., Bozeman, Miles City, Cody) may need different plan contacts and have different vendors.
• Creates reports in support of enrollment audit function, or Payer Relations research for special projects.
• Identifies and implements process improvements in all aspects of the provider enrollment process. Participates in and/or leads and facilitates teams and committees as appropriate.
• Identifies needs and sets goals for own growth and development; meets all mandatory organizational and departmental requirements.
• Performs other duties as assigned or needed to meet the needs of the department/organization.

Minimum Qualifications
Education

• 
  Minimum High School or GED
• Preferred 2 Year / Associate Degree
• Some college coursework in the areas of business, accounting, or finance preferred

Experience

• Demonstrated ability to understand and develop information using databases and creating complex spreadsheets
• Appropriate experience in healthcare billing, insurance contract development, medical staff credentialing and/or experience working in a healthcare insurance company preferred

Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered. Employees that require a licensed or certification must be properly licensed/certified and the licensure/certification must be in good standing.

Billings Clinic is Montana’s largest health system serving Montana, Wyoming and the western Dakotas. A not-for-profit organization led by a physician CEO, the health system is governed by a board of community members, nurses and physicians. Billings Clinic includes an integrated multi-specialty group practice, tertiary care hospital and trauma center, based in Billings, Montana. Learn more at www.billingsclinic.com/aboutus

Billings Clinic is committed to the principles of Equal Employment Opportunity. All policies and processes are designed toward achieving fair and equitable treatment of all employees and job applicants. Employees are encouraged to discuss any concerns they have in this regard with their immediate supervisor and/or the Vice President People Resources. All employees and job applicants will be provided the same treatment in all aspects of the employment relationship, regardless of race, color, creed, religion, national origin, gender, gender identity, sexual orientation, age, marital status, genetic information or disability.