Business Process Delivery professionals execute repeatable core business processes and/or technical transactions with a focus on efficiency, first-time quality and overall continuous process improvement.
Job Description
The job duties for the Provider Enrollment Business Analyst are as follows:
- Interact professionally with providers and ancillary staff to provide appropriate and timely response to inquiries and concerns regarding provider enrollment and file maintenance for Medicaid programs (including dental, vision, ambulance, physicians, nurses and all other provider types)
- Process to completion 100% of assigned applications utilizing documented work instructions, daily and meet minimum daily quotas
- Provider outreach and assistance in completing electronic enrollment applications unacceptable to the system
- Data entry (of paper applications) with validation of provider submitted enrollment information to insure the enrollment application meets the minimum standards
- Respond to inquiries regarding status of applications received
- Research and contact providers to resolve enrollment application deficiencies
- Perform liaison role between business operation departments and IT from project initiation to post implementation on responsibilities include the overall planning, organizing, directing, controlling and delivery of all projects prioritized in alignment with the customers expectations and business needs. communicating changes in scope, requirements and/or functional design with departmental leadership. developing recommended solutions in consultation with departmental leadership.
- Adhere to Quality Assurance program in order to improve daily processing of applications and file maintenance transactions with a minimum quality score of 98%
- Monitor and Review Quality Assurance results in order to improve daily processing of applications and file maintenance transactions
- Makes recommendations to management to improve efficiency/effectiveness of current manual processes through systemic modifications
- Maintain strict confidentiality of information and job files as dictated by current HIPAA requirements
- Respond to Tier III escalations and/or file maintenance requests as assigned within the specified due dates
- Flexibility to work overtime as dictated by daily production inventory requirements
- Perform other duties as assigned by leadership
Basic Qualifications:
- Bachelors Degree in Business Administration or Healthcare Administration or related disciplines or High School Diploma and 1 additional years of work experience in Health Care related industry.
- Minimum of one year of experiencein the enrollment credentialing of healthcare providers
Preferred:
- Minimum 1years experience in customer service, public relations, education or related field - Personal Computer experience (Microsoft Office Suite)
- Proven ability to work independently and as a team member
- Good communication (written and oral) and interpersonal skills
- Good organizational, multi-tasking, and time-management skills
Professional Skill Requirements
- Eagerness to contribute in a team-oriented environment
- Ability to work creatively and analytically