Remote Highmark Blue Shield Jobs in California (NOW HIRING)

Remote, Nationwide - Seeking Provider Enrollment Specialist

Everybody Has A Role To Play In Transforming Healthcare

At Vituity you are part of a larger team that is driven by our purpose to improve lives. We are dedicated to transforming healthcare through our culture by working together to tackle healthcare's most pressing challenges from the inside.

Join the Vituity Team. At Vituity we've cultivated an environment where passion thrives, and success comes through shared purpose. We were founded in a culture that values team accomplishments more than individual achievements, an approach we call "culture of brilliance." Together, we leverage our strengths and experiences to make a positive impact in our local communities. We foster this through shared goals and helping our colleagues succeed, and we also understand the importance of recognition, taking the time to show appreciation and gratitude for a job well done.

Vituity Locations: Vituity has opportunities at 900 practices across the country, serving 14.5+ million patients a year. With Vituity, if you ever need to move, you can take your job with you.

The Opportunity

• Prepare, submit, and scan approximately 1,000 provider enrollment applications per year for Medicare, Medicaid, Blue Cross, Blue Shield, CAQH and other payer programs as needed and is responsible for all aspects of payer portal access for individual providers.
• Submit all applications to supervisor/manager for audit, working towards an error rate of less than 10%.  
• Monitor submitted provider enrollment applications to ensure approvals are received and communicated to billing team prior to timely filing, working towards the team's overall goal of not having pending applications over 6 months after the start date.  
• Approvals are received and communicated to billing team prior to timely filing, working towards the team's overall goal of not having pending applications over 6 months after the start date.  
• Manage daily administrative duties with an emphasis on enhancing efficient workflows.
• Prioritize requests, manage time, and workload to execute project plans within given deadlines.  
• Comfortable with working remotely full-time. Ability to work independently with little guidance and adapt.  
• Respond to internal and external inquiries on routine enrollment and contract matters, including follow-up with payers on applications as frequently as every 2 weeks.
• Serve as liaison between billing company, providers, and payer representatives to resolve all provider enrollment issues with assistance from supervisor/manager.
• Coordinate credentialing process with assistance of an on-site administrator as needed to complete credentialing for initial, updating, and add-on applications and maintenance processes.
• Communicate with providers and other departments to update as needed, clarify carrier information requirements, and maintain a strict level of confidentiality for all matters pertaining to provider credentials.
• Salesforce configuration changes including but not limited to record types, dashboards, reports, and custom settings.  
• Update records in Salesforce with billing numbers, contract information, submission dates of applications, and notation of any communications or problems that require attention. Record extensive documentation in databases for any ongoing or open tasks.
• Ability to use Salesforce data loader for bulk import of data to individual enrollment contracts.  
• Ability to use DocuSign to send out PE documents, obtain required client signatures, and follow up with the carriers on documentation submitted.  
• Deactivate inactive providers from Medicare, Medicaid, and other payers to remain compliant with federal and state regulations.
• Ensure data integrity and participate in trainings and development to mitigate compliance risk with state and federal regulations.  
• Work with multiple departments to review proforma for new contracts and assist to protect revenue.
• Learn to research numerous payer issues and work to resolve with payers and billing company quickly and effectively with oversight from supervisor/manager with overall goal to lose less than $100K in revenue per year.  
• Contribute and assist with implementation of process improvement ideas by participating in payer trainings and webinars as needed.
• Support research, review, and testing of educational materials for organization growth.

Required Experience and Competencies

• HS Diploma in combination with relative work experience required.
• 2-4 years related healthcare experience required.
• Bachelor's degree is preferred.
• 3+ years of related healthcare experience preferred.
• Knowledge of billing or reimbursement is desired
• Provider Enrollment experience is desired
• Ability to effectively interact with providers, payer representatives, internal departments, team members, and other stakeholders, both in written and verbal communication.
• Ability to accomplish tasks thoroughly and accurately
• Ability to effectively manage time and organize
• Ability to learn billing processes, including timely filing and claims denial reasons
• Proficient in Microsoft Office Suite (Word, Excel, Outlook, OneNote, OneDrive, PowerPoint, etc.)
• Knowledge of additional technology-based assistance (Teams, SharePoint, etc.)
• Knowledge of online Medicare/Medicaid enrollment systems, Identity & Access system, Counsel for Affordable Quality Healthcare system, Medicare enrollment specialties, and National Provider Identifier taxonomies
• Knowledge of Medicaid enrollment process (including revalidations, medical license expirations, deactivations, NPI taxonomy importance, how data flows to Medicaid managed cares, Medicaid billing manuals, state administrative codes, border state enrollment process, out of state enrollment process, etc.)
• Knowledge of Salesforce (including Individual Enrollment Contracts, Group Enrollment Contracts, Contracts, Work History, Provider Status, and Clinical Activities objects), and utilizing dashboards and reporting to develop internal preference for ongoing workload management
• Develop critical thinking skills and professional relationships

The Community

Even when you are working remotely, you are an important part of the Vituity Community. We offer plenty of opportunities to engage with other Vitans through a variety of virtual meet-and-greets, events and seminars.

• Monthly wellness events and programs such as yoga, HIIT classes, and more.
• Trainings to help support and advance your professional growth.
• Team building activities such as virtual scavenger hunts and holiday celebrations.
• Flexible work hours.
• Opportunities to attend Vituity community events including LGBTQ+ History, Dia de los Muertos Celebration, Money Management/Money Relationship, and more.

Benefits & Beyond*

Vituity cares about the whole you. With our comprehensive compensation and benefits package, we are mindful of what matters most, and support your needs of today and your plans for the future.

• Superior health plan options
• Dental, Vision, HSA/FSA, Life and AD&D coverage, and more
• Top Tier 401(k) retirement savings plans that offers a $1.20 match for every dollar up to 6% plus discretionary profit-sharing contributions (eligible January following 18 months of service)
• Generous paid time off starting 3-4 weeks' annually
• Student Loan Refinancing Discounts
• Professional and Career Development Program
• EAP and travel assistance included
• Wellness program
• Purpose-driven culture focused on improving the lives of our patients, communities, and employees

We are excited to share the base salary range for this position is $22.90 - $28.63, exclusive of fringe benefits or potential bonuses. This position is also eligible to participate in our annual corporate Success Sharing bonus program, which is based on the company's annual performance. If you are hired at Vituity, your final base salary compensation will be determined based on factors such as skills, education, and/or experience. We believe in the importance of pay equity and consider internal equity of our current team members as a part of any final offer. Please speak with a recruiter for more details.

We are unified around the common purpose of transforming healthcare to improve lives and we believe everyone has a role to play in that. When we work together across sites and specialties as an integrated healthcare team, we exceed the expectations of our patients and the hospitals and clinics we work in. If you are looking to make a difference, from clinical to corporate, Vituity is the place to do it. Come grow with us.

Vituity does not discriminate against any person on the basis of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information (including family medical history), veteran status, marital status, pregnancy or related condition, or any other basis protected by law. Vituity is committed to complying with all applicable national, state and local laws pertaining to nondiscrimination and equal opportunity.

*Benefits for part-time and per diem vary. Please speak to a recruiter for more information.

Applicants only. No agencies please.