Government Enrollment Specialist Managed Care

Coordinates the day-to-day administration of Adventist Health System's (AHS) Medicare and Medicaid provider enrollment program, ensuring that all existing and new physicians and other billing health care providers in the AHS system are enrolled in compliance with all affiliation and participation requirements, as well as regulatory and internal policy requirements.

• Coordinates the day-to-day administration of Adventist Health System's (AHS) Medicare and Medicaid provider enrollment program, ensuring that all existing and new physicians and other billing health care providers in the AHS system are enrolled in compliance with all affiliation and participation requirements, as well as regulatory and internal policy requirements.
• Collaborates with other departments, such as provider onboarding, credentialing, and revenue cycle, to gather necessary information and ensure a smooth application process.
• Offers support and guidance to provider onboarding throughout the application process, answering questions, providing updates on application status, and assisting with any issues.
• Monitors the status of all applications, following up with regulatory agencies as needed to ensure timely processing and approval, and maintaining a tracking system to monitor progress.
• Acts as the primary point of contact with Medicare/Medicaid regulatory agencies, submitting applications, responding to inquiries, and addressing any issues that arise during the approval process.
• Identifies any issues or delays in the application process and works to resolve them promptly, troubleshooting problems, coordinating with other departments, or escalating issues to higher management.
• Reviews and verifies all documentation submitted by new physicians and advanced practitioner providers to ensure completeness and accuracy, contacting applicants for additional information or clarification if needed.
• Ensures that all new physicians and advanced practitioner providers are enrolled in Medicare/Medicaid programs in a timely manner, allowing them to begin billing for services as soon as possible.
• Prepares for and assists with internal and external audits related to the Medicare/Medicaid application process, ensuring that all records are accurate and up-to-date and providing any requested documentation to auditors.
• Continuously evaluates the application process and recommends improvements to increase efficiency and compliance, updating procedures, implementing new technologies, or providing training to staff.
• Oversees the entire Medicare/Medicaid application process for new physicians and advanced practitioner providers, ensuring timely and accurate submission of all required documentation.
• Ensures that all applications comply with federal, state, and organizational regulations and policies, staying updated on any changes in Medicare/Medicaid requirements and implementing necessary adjustments.
• Keeps accurate and organized records of all applications, including tracking the status of each application, maintaining copies of submitted documents, and recording any communications with regulatory agencies.

• Attentive to detail and accuracy; strong organization skills required.
• Working knowledge and understanding of all rules, regulations, policies, and procedures with regard to health care professional billing under Medicare/Medicaid.
• Ability to communicate effectively, both orally and in writing.
• Analytical, evaluative, and critical thinking skills.
• Knowledge and understanding of electronic data collection and data management systems and procedures.
• Ability to prioritize and manage a demanding workload.
• Working familiarity with Medicare/Medicaid provider billing requirements in all states where AHS has provider medical groups.
• Knowledge of AHS medical practice billing procedures and systems as they relate to Medicare/Medicaid.
• Skill in the use and administration of specialized electronic medical billing applications.
• Strong interpersonal skills and ability to work effectively at all levels in a collaborative team environment.

• Benefits from Day One
• Career Development
• Whole Person Wellbeing Resources
• Mental Health Resources and Support

AdventHealth is a faith-based health care organization headquartered in Altamonte Springs, Florida. As a national leader in quality, safety and patient satisfaction, our 92,000 team members maintain a long tradition of whole-person health by caring for the physical, emotional and spiritual needs of every patient.