Enrollment Specialist II

Builds, manages, and maintains overall patient care duties and customer relationships for the department including new patient sign-on and establishing and nourishing the relationship with inside sales, outside sales, provider contacts, and patients. Validates proper documentation and prepares pre-authorization requirements.

Builds and maintains strong, professional relationships with prospective patients, health care professionals, manufacturing partners and inside / outside sales force

• Handles inbound and outbound calls from patients, physicians, and referral sources to ensure patient satisfaction, troubleshoot new and existing patient concerns, add services, verify, and explain insurance coverage to patients

• Achieves stated revenue goals, production, and performance objectives

• Ensure all medical documents, patient accounts and files are updated, consistent and complete

• Assesses patients' needs and coordinates with physicians' orders and insurance plans

• Demonstrates accountability and responsiveness to the needs of the patients

• Collects and validates proper documentation required by insurance plan

• Escalate recurring problem accounts or physician groups or other trends to management

• Updates PIMS workflow (and/or Brightree WIP state) for reporting purposes

• Coordinates training with manufacturer or doctor's office

• Always maintains a high degree of confidentiality due to access to sensitive information

• Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department

• Follows all Medicare, Medicaid, HIPAA, and Private Insurance regulations and requirements

• Abides by all regulations, policies, procedures, and standards

• Exercises appropriate cost control measures

• Maintains positive internal and external customer service relationships

• Maintains open lines of communication

• Plans and organizes work effectively and ensures its completion

• Meets all productivity requirements

• Demonstrates team behavior and promotes a team-oriented environment

• Actively participates in Continuous Quality Improvement

• Represents the organization professionally at all times

The successful candidate will hold previous inside sales or account management experience in the health care field.

• High School diploma or GED equivalent

• Must be able to successfully perform all the functions of an Enrollment Specialist I

• Has a strong working knowledge of billing procedures, insurance reimbursement procedures and HCPC codes

• Ability to analyze and correct accounts receivable problems

• Proficient in Microsoft Outlook, Word, Excel, PowerPoint, and computer literacy

• Knowledge of government and commercial insurance payers as it relates to documentation of claims that are required before submission

• Ability to understand Medical Records documents such as safety rules, operating and maintenance instructions, and procedure manuals

• Position requires evening and weekend availability

• Effective multi-tasker with time management and organizational skills

• Demonstrated ability to accurately perform data entry and pay close attention to detail

Certainty-The lives of the individuals we serve depend on our ability to execute. We commit to doing this every day.

• Use appropriate methods and a flexible interpersonal style to help build a cohesive and collaborative team based on a foundation of trust and transparency. Deliver what you commit to.

Compassion-We understand the burdens of patients and their loved ones and channel this into a relentless pursuit of customer satisfaction in every part of our business.

• Ensure that the patient is the driving force behind business decisions, implementing service practices that meet the needs of both the patient and the organization. Treat others the way you want to be treated.

Advancement-We are endlessly looking for ways to progress and become more innovative in all things we do.

• Encourage innovative approaches for addressing opportunities and facilitating change, driving cross-functional alignment to accomplish goals. Speak the truth.
• CCS Medical and EEOC/AA employer. M/F/D/V

Working conditions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to sit, talk, hear; use hands to finger, and handle controls. The employee frequently is required to reach with hands and arms. The employee is occasionally required to stand, walk, and stoop. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Environment: Moderate noise level similar to a typical office environment with computers, printers, and work activity