Healthcare Without Rival
Premise Health is the world's leading direct healthcare provider and one of the largest digital providers in the country, serving over 11 million eligible lives across more than 2,500 of the largest commercial and municipal employers in the U.S. Premise partners with its clients to offer fully connected care – in-person and in the digital environment. It operates more than 800 onsite and nearsite wellness centers in 45 states and Guam, delivering care through the Digital Wellness Center and onsite, nearsite, mobile, and event solutions.

Premise delivers value by simplifying complexity and breaking down barriers to give diverse member populations access to convenient, integrated, high-quality care. We offer more than 30 products, delivering the breadth and depth of care required to serve organizations' total populations. The result is healthcare that meets the needs of members and their families, helping them live healthier while lowering costs for organizations.

Premise offers a wide range of dynamic, purpose-driven career opportunities. We are currently looking for an EDI Enrollment Specialist to join our team in Brentwood, TN.

About the role: The EDI and Enrollment Specialist (EES) facilitates and manages provider enrollment for all new and existing clients as well as obtaining and managing all Location NPIs, NCPDP’s and assigning appropriate tax ID’s to each. They develop, coordinate, implement, and manage all payer/EDI-related processes. Additionally, the EES serves as the primary link between Premise and any claims/payer data-trading partners and vendors and manages those relationships. The purpose of the EES’ job is to ensure all items are accurately obtained, tracked, setup, updated and communicated for each implementation and/or payer/provider change.

Essential Functions:

• Obtains and tracks all location NPIs for applicable centers
• Completes all documents and tracks process for billing providers and/or group enrollment with applicable payers
• Collaborates with vendor(s) and serves as the primary contact for vendor services related to claims and enrollment
• Adheres to deadlines and enrollment schedules by tracking files through all stages
• Adheres to deadlines and enrollment schedules by tracking files through all stages
• Maintains and updates all provider CAQH accounts
• Applies for and manages all NCPDPs for provider dispensing
• Registers new sites, staff, providers and RCM Account Managers with Navinet, Availity and One Health Port
• Works with operations, providers, legal, licensing and PC Authorized officials on enrollment and contracting essentials needed for completion and sign-off
• Manages the processes associated with new and change payer set ups as it relates to 270/271 eligibility, 837/835 files and EFT’s
• Responsible for updating workflow processes and documentation related to enrollment
• Meets all deadlines for implementations, changes and updates
• Communicates progress of implementations, changes and completion to leadership as it relates to enrollment (payer, Navinet, Availity, One Health port and CAQH), location NPIs and NCPDPs.
• Serves as SME for RCM as it relates to billing issues around provider and/or group payer enrollment
• Collaborates with other Revenue Cycle staff, Operations, Providers, Legal and Leadership Teams

Job Requirements:

• High School Graduate, minimum education requirement or equivalent work experience
• A minimum of 3 years experience working with EDI or enrollment platforms
• Experience working with multiple different carrier specifications
• A minimum of 3 years experience credentialing/provider enrollment and/or payer contracting
• A minimum of 2-3 years’ experience in billing and collections revenue cycle, preferred

Preferred Experience:

• Demonstrated successful physician third party billing leadership experience
• Possess strong analytical, problem solving and decision-making skills
• Effectively utilize Microsoft Office tools (Excel, Word, and PowerPoint)
• Highly developed written and verbal communication skills
• Knowledge of CPT and ICD10 coding, preferred
• Background working in practice management system(s). Knowledge and use of EPIC is a plus.
• Attention to detail and highly effective planning, organizational, time management and prioritization skills
• Must be able to work independently in a manner to achieve goals, objectives and productivity requirements.

Work-life balance is at the foundation of how decisions are made and where Premise is headed. We can only help people get, stay, and be well if we do the same for ourselves. In addition to competitive pay, Premise offers benefits packages including medical, dental, vision, life insurance, 401(k), paid holidays and vacation time, a company-sponsored wellness program, and much more our talent acquisition team will be happy to share with you.

Premise Health is an equal opportunity employer; we value inclusion, and we do not discriminate based on race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status or disability status.

To support Premise Health’s commitment to the safety, health and wellbeing of our team members, clients and patients, Premise Health encourages all new team members to be fully vaccinated and up to date with a COVID-19 vaccine. Where applicable state or local laws or a client require, individuals who are offered and accept a position with Premise Health will be required to provide proof of vaccination in the form of a CDC vaccination card as part of the pre-employment onboarding process.

*Except where a reasonable medical or religious accommodation can be granted.

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