Health Systems Specialist - Phoenix, United States - Department Of Health And Human Services

Description

Summary

This position is located at the Phoenix Indian Medical Center (PIMC), Division of Financial Services, Patient Business Services in Phoenix, Arizona. The position serves as the Provider Enrollment Specialist responsible for initiating provider and facility enrollment applications for Centers for Medicare and Medicaid Services (CMS), Arizona Medicaid (AHCCCS), California Medicaid (Medi-Cal), Nevada Medicaid, New Mexico Medicaid, and various private insurance or managed care plans.

Duties

• Serves as the facility or provider authorized organizational official to review and complete CMS, state Medicaid, private insurance, and managed care applications. Submits with administrative approval.
• Serves as the liaison/ facility point of contact for the National Provider Identifier (NPI) and Provider Enrollment, Chain of Ownership System (PECOS) for all medical staff.
• Initiates, revalidates, or re-enrolls provider or facility applications for CMS, state Medicaid programs (Arizona, California, Nevada, and New Mexico). Includes but not limited to obtaining all necessary documentation to complete an application
  
  (credentialing information, medical license(s), etc.), obtain signatures and submit.
• Assists with the collection of data for the CMS Merit-based Incentive Payment System (MIPS) program as defined by CMS for eligible professionals and hospitals.
• Assists the facility and providers in adding or updating information for National Plan and Provider Enumeration System (NPPES, Medicare - Provider Enrollment, Chain and Ownership System (PECOS), Arizona AHCCCS incentive payment system (e-PIP), and CMS Identify & Access Management System (l&A).
• Analyzes and evaluates (on a quantitative or qualitative basis) the effectiveness of program operations in meeting established goals and objectives for provider enrollment, reporting requirements and timeliness of organizational responses and performance reporting.