Mount Sinai Careers
FPA PROVIDER ENROLLMENT ANALYST I - FPA Administration (CBO)
Strength Through Diversity
Ground breaking science. Advancing medicine. Healing made personal.
Roles & Responsibilities:
The Provider Enrollment Analyst (I) is
responsible for coordinating the provider enrollment and payer credentialing
efforts for contracted FPA providers with Medicare and Medicaid. This
individual assists in all open provider enrollment tasks and issues to ensure
that providers are reimbursed for services provided and billed.
Duties and Responsibilities:
- Enrolls and terminates providers with CMS and other government programs by completing 855 series forms, gathers credentials and associated documentation required for enrollment and process enrollment forms
- Tracks status of "in process" enrollment forms until final approval received
- Files provider ID numbers once assigned by governing agencies and performs system updates as appropriate
- Responsible for the initial setup of new groups and providers for 837P and 835P EDI transactions as well as EFT
- Monitors TES edits, BAR edits, eCommerce edits, and payer denials for issues related to enrollment, and follow-up on claims until resolved
- Coordinates all CBO rebilling efforts due to provider enrollment issues
- Communicates with providers and other departments to escalate issues, share information and promote the process of obtaining documentation required for enrollment
- Assists department administrators and providers in performing online PECOS enrollment
- Responsible for end-to-end Revalidation letter process, downloading list from CMS, obtaining comparison reports from the Medicare Provider Enrollment Database and scheduling providers for online re-enrollment
- Utilizes the reports within the Medicare Provider Database to monitor updates, promptly complete work orders and identify work to be completed
- Performs special projects, reconciliations, research, and analyses, as directed by Management
- Assists management with Meaningful Use and PQRI tracking and reporting
- Supports activities related to internal and external audits of providers and/or departments
- Responds to inquiries and provide information as requested
- Performs other related duties as assigned
- Bachelor's degree preferred, or equivalent years of Provider/Facility Enrollment or Credentialing experience
- Medical Group and Health Plan knowledge preferred
- Excellent verbal and written communication and computer skills
- Knowledge of facility based billing/reimbursement methodologies including APCs, as well as knowledge of federal, state and payer specific regulations and policies is a plus
- In depth knowledge of CPT4 and ICD9 Coding
- Two years of healthcare experience including Medicare or Medicaid Provider or Facility Enrollment or Credentialing experience required
- Two years of Revenue Cycle operations and processes experience required, as well as direct customer service experience required
- Strong analytical, interpersonal, communication, conflict resolution, problem solving and organizational skills required
- Proficiency with 855 series forms, PECOS and NPPES online systems required
- Demonstrated excellent written and oral communications skills required
- Ability to handle multiple tasks and meet required deadlines required
- Ability to be thorough and follow through on detail required
- Working knowledge of insurance regulations, as they pertain to provider enrollment with payers and government programs
- Ability to maintain high level of accuracy in multiple databases and tracking spreadsheets containing confidential and secure information
- Proven ability to work in a team setting as well as independently
- Ability to use good judgment.
Strength Through Diversity
The Mount Sinai Health System believes that diversity and inclusion is a driver for excellence. We share a common devotion to delivering exceptional patient care. Yet we’re as diverse as the city we call home- culturally, ethically, in outlook and lifestyle. When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education and advancement as we revolutionize healthcare delivery together.
We work hard to recruit and retain the best people, and to create a welcoming, nurturing work environment where you have the opportunity and support to develop professionally. We share the belief that all employees, regardless of job title or expertise, have an impact on quality patient care.
Explore more about this opportunity and how you can help us write a new chapter in our story!
Over 38,000 employees strong, the mission of the Mount Sinai Health System is to provide compassionate patient care with seamless coordination and to advance medicine through unrivaled education, research, and outreach in the many diverse communities we serve.
Formed in September 2013, The Mount Sinai Health System combines the excellence of the Icahn School of Medicine at Mount Sinai with seven premier hospitals, including Mount Sinai Beth Israel, Mount Sinai Brooklyn, The Mount Sinai Hospital, Mount Sinai Queens, Mount Sinai West (formerly Mount Sinai Roosevelt), Mount Sinai St. Luke’s, and New York Eye and Ear Infirmary of Mount Sinai.
The Mount Sinai Health System is an equal opportunity employer. We promote recognition and respect for individual and cultural differences, and we work to make our employees feel valued and appreciated, whatever their race, gender, background, or sexual orientation.