Provider Enrollment Manager
Join Our Life-Saving Team in Phoenix, Arizona!
Are you ready to elevate your career to new heights? PHI Health is looking for dynamic, driven individuals to join our Patient Financial Services Team team. We are committed to providing top-tier emergency medical services with unmatched speed and efficiency, saving lives when every second counts. By supporting our mission from the ground, you will play a crucial role in orchestrating the seamless operations that keep our advanced fleet soaring and our patients safe.
As a Provider Enrollment Manager, youll collaborate with some of the best minds in the industry, driving initiatives that enhance our services and expand our reach to those who need it most. If youre passionate about making a difference and thrive on challenges, PHI Health offers an extraordinary opportunity to impact lives and develop your professional career in a meaningful way.
Who We Are:
PHI Health is the leading air ambulance provider in the United States. With an unmatched safety record and the best aviation, medical and communication specialists in the field, we set the standard in the air medical industry. We transport more than 22,000 patients each year from our more than 80 bases across the country, all while offering services and outreach education to local communities and leading healthcare systems. Our mission is simple: move communities to health while maintaining the highest standard of safety, period.
Job Summary:
The Provider Enrollment Manager will play a pivotal role in the implementation and management of a new claims clearinghouse vendor relationship. This individual will be responsible for ensuring the seamless integration of electronic data interchange (EDI) processes with the new vendor to maximize efficiency and accuracy claims data exporting from PHI billing system to Vendor application system. The successful candidate will possess a strong understanding of healthcare billing practices, EDI standards, and claims processing workflows.
Essential Responsibilities include:
- Lead the implementation of EDI solutions with the new vendor, including configuration, testing, and deployment of EDI transactions (e.g., claims, remittance advice, eligibility inquiries, and credit card transactions).
- Guide and participate in payer enrollments or registrations as required to file claims through the clearinghouse.
- Develop and maintain EDI maps and translation specifications to ensure accurate data transmission between internal systems and the claims clearinghouse.
- Monitor EDI transaction activity and troubleshoot errors or discrepancies to ensure timely and accurate claims processing.
- Provide training and support to end-users on EDI processes, tools, and best practices.
- Stay current on industry trends, regulatory changes, and best practices related to healthcare EDI standards and revenue cycle management.
- Collaborate with IT teams to address technical issues and enhance EDI infrastructure and capabilities.
- Interface with PFS Project Manager for manage EDI related projects.
- Generate reports and analytics to track key performance indicators (KPIs) related to EDI processing and revenue cycle performance.
- Participate in cross-functional teams and projects aimed at optimizing revenue cycle operations and improving financial outcomes.
Accountabilities and Oversight
- In order to facilitate the prompt and accurate payment of submitted claims the Provider Enrollment Specialist must develop, coordinate, implement and manage provider enrollment (PE), electronic data interchange (EDI), electronic funds transfer (EFT), electronic remittance advice (ERA) and payer web portal requirements with governmental and commercial payers.
- Must demonstrate outstanding attention to detail skills in order to facilitate obtaining the appropriate signatures and verify application accuracy prior to submission.
- Strong communication and interpersonal relationship development with payers both for initial enrollment and for managing changes brought about by regulatory requirements.
- Develop in-depth knowledge of payer policies, regulations, requirements and necessary forms for multiple states.
- Navigate a myriad of payer systems to understand specific process requirements as well as utilize the specific on-line tools for managing the status of enrollments, electronic claims status, remittances, payments and clearinghouse activities.
- Collaborate with internal stakeholders to assess current EDI processes and identify opportunities for improvement.
- Serves as the initial contact for trouble shooting, monitoring document transmissions, and identifying opportunities for process improvements regarding government payers.
- Communicates and works closely with Patient Financial Services, Cash Posting, GE Billing Services, Operational and Compliance leadership and provide technical support to facilitate the prompt flow of revenue in a compliant manner.
- Request and organize supporting documentation to accompany various provider enrollment applications from multiple departments, including but not limited to PHI Health, LLC and/or PHI Group, Inc. Corporate Operations, Corporate Compliance, Legal, Risk Management, Tax, Patient Financial Services, Aviation, Clinical and Financial Services.
- High level of awareness of PHI Group, Inc., PHI Corporate, LLC and PHI Health, LLC organizational structure in order to provide accurate information to governmental entities assuring the correct corporation/legal entity is represented on applications.
- Develop and maintain database of all EMS licenses for all base locations to assure consistency with submitted documentation.
Schedule/Location
The successful candidate will have:
- Bachelors degree in healthcare administration, business, information technology, or related field.
- Minimum of 2 years of experience in PFS management, with a focus on EDI processes and transactions.
- In-depth knowledge of EDI standards (e.g., HIPAA X12, ANSI ASC X12), including experience with transaction sets such as 837, 835, and 270/271.
- Experience working with claims clearinghouse vendors and implementing EDI solutions within a healthcare organization.
- Strong analytical skills and attention to detail, with the ability to troubleshoot and resolve EDI-related issues.
- Excellent communication and interpersonal skills, with the ability to effectively collaborate with internal and external stakeholders.
- Proficiency in healthcare billing software, practice management systems, and EDI tools.
- Certifications such as, SQL Certification, Certified Professional Biller (CPB) or Provider Enrollment Specialist Certificate (PESC) are preferred.
- Knowledge of healthcare reimbursement methodologies, payer policies, and regulatory requirements.
Our Core Competencies:
- Safe. We are absolute in our belief in the tenets of Destination Zero and that Zero is not only achievable, but the only acceptable outcome.
- Efficient. We are focused on outcomes that are smart and responsible by making the best use of our resources to maximize overall productivity and achieve sustainable profitability as a high performing organization.
- Quality. We are committed to ensuring excellent organizational performance which produces sustainable and reliable outcomes.
- Service. We are dedicated to the service of our customers, our communities and each other.
The PHI Health Advantage
For more than 40 years, our company has been providing critical air medical transport services across the country. As an organization, we outfit each aircraft we fly with the most advanced technology, subject our crews to the most rigorous protocols and training and pioneer the most-forward thinking safety program in the country.
Everything that we do comes back to the safety of our crew and our patients. Our accident rate is well below the national average and we were the first to receive the Vision Zero Aviation Safety Award. This belief has guided us towards a number of industry firsts and has given us the highest safety rating in the industry.
