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The School of Dentistry employs approximately 125 faculty, 200 affiliate faculty, 275 classified and professional staff and has an enrollment of 300 pre-doctoral and graduate students. The School also provides residency opportunities for 65 resident professionals in Dentistry, Oral Surgery and Oral Medicine. The School is one of the top dental schools in the world and the only public dental school in the Pacific Northwest region. Under the guidance of eight academic specialty departments, the School educates the dentists of the future in its pre-doctoral DDS program. Departments also provide intensive graduate education in specialty areas of dentistry including pediatric dentistry, oral surgery, oral medicine, endodontics, orthodontics, periodontics and restorative dentistry. Regional programs like RIDE (Regional Initiatives in Dental Education) extend the School’s educational programs and patient care services to rural areas in Washington, Alaska and Montana.
As part of the service-learning component of its educational programs and faculty service, the School of Dentistry (SoD) annually provides oral health services to approximately 65,000 individual patients who are often disadvantaged, underserved and in need of significant oral health care. In FY 2019, the School hosted nearly 90,000 patient visits in 13 clinics housed in facilities in the Health Sciences Building on the Seattle Campus, 2 in the UW-owned Washington Dental Service building at Sand Point, and at off-site medical centers at Harborview and Seattle Cancer Care Alliance as well as numerous community healthcare centers across the state. The School of Dentistry actively supports and values diversity, equity, and inclusion at all levels of its organization.
The School of Dentistry has an outstanding opportunity for a Provider and Contract Enrollment Specialist.
Reporting to the Director of Patient Revenue Cycle, the Provider and Contract Enrollment Specialist is responsible for developing and maintaining a UW School of Dentistry insurance contract and provider enrollment program for all providers who submit claims or treat patients using the SoD’s axiUm billing system. This contract/enrollment program ensures patient access through enrollment in insurance networks - and prompt reimbursement for designated insurance plans accepted by clinics and providers.
Enrollment in and evaluation of payer contracts and provider recredentialing: 60%
•Use independent judgement to evaluate, initiate, and maintain third-party contracts between School of Dentistry billing provider groups and third-party payers; •Update existing contracts and enrollments to ensure correct association between provider, provider group NPI, practice address, and tax ID; •Develop a communication strategy to serve as resource for questions about terms of contract such as fee structure, network participation criteria and status; •Enroll provider credentials and department billing NPI’s with private and public third party payer contracts through accessing online portals such as One Health Port, CAQH (Coalition for Affordable Quality Healthcare) Credentialing Services, or others as required by payer; •Use Provider One portal to enroll providers (including affiliate faculty) in Washington State Medicaid contracts, including correct association with provider types, taxonomies, billing NPI’s, and Provider One billing domains •Use Medicare PECOS system to enroll new providers in Medicare contract, including correct association with provider group, appropriate CMS forms 855R and 855B; •Enroll limited provider groups in out-of-state Medicaid plans including Alaska, Idaho, and Montana; •Respond to commercial and public payer provider recredentialing and revalidation requests in a timely manner, using payer-specific credentialing methods; •Observe state regulations concerning inter-state reciprocity regulations and in-state credentialing, according to payer •Contact faculty to obtain relevant signatures, professional licenses, DEA certificates, insurance liability certifications, and other payer-specific forms to accompany enrollment and credentialing applications; •Access provider information from public resources such as Washington State Department of Health, National Plan and Provider Enumeration System (NPPES) •Submit W-9’s and payer-requested applications for in-network and out-of-network plans; •Review and update provider files and on-line payer directories to reflect changes in provider clinic locations, email contacts, phone numbers for patient appointments due to changes in service locations, provider separation from department; •Contact payers to dis-enroll providers from contracts as appropriate; •Update provider contracts with changes to tax ID, sub-tax ID, and billing NPI’s; •Act as School of Dentistry point of contact for payer credentialing specialists, provider services, and provider enrollment departments; •Collaborate with providers and administrators to obtain information necessary for applications, updating internal database; •Review signed applications for accuracy and completeness; •Maintain confidentiality regarding provider files, backgrounds, license enforcement actions, credentials.
Communicate enrollment/contract status: 20%
•Develop and maintain database to anticipate recredentialing requests for existing providers •Maintain electronic and physical files on contracts, tracking start dates, expiration dates, contract updates, and fee schedule changes; •Communicate quarterly with department administrators to confirm current roster of providers and upcoming recredentialing deadlines; •Collaborate with Patient Revenue Cycle Office staff, School of Dentistry Clinic managers, administrators, and IT staff to ensure timely enrollment and accurate updates to axiUm billing system; •Establish collaborative working relationships with provider enrollment departments, especially with representatives from common in-network payers; •Communicate provider enrollment, credentialing, and contracting status School-wide by clinic, provider, and specialty.
Support Revenue Cycle staff functions: 10%
•Perform regular review of accounts in axiUm system to monitor provider enrollment issues •Manage on-line portal payer access for School of Dentistry users, including One Health Port, Availity, Emdeon/Change Healthcare electronic claims, Noridian/Medicare; •Communicate with SoD IT to update and evaluate provider, billing group setups for accurate claim submission; •Participate in process improvement efforts to develop timely, responsive, and transparent enrollment process.
Fee schedule maintenance: 10%
•Process internal fee updates/requests to update fee schedules in axiUm billing system; •Review and update fees associated with contracts; •Participate in quarterly fee schedule reviews, audits to ensure reimbursements follow contractual agreements.
•Bachelor’s Degree in Business Administration or related field or equivalent experience. •Two to Three years experience in a healthcare field
Equivalent education/experience will substitute for all minimum qualifications except when there are legal requirements, such as a license/certification/registration.
•Experience working with Word, Excel, PowerPoint, Adobe/Acrobat •Excellent verbal and written communication skills •A combination of education and experience that provides comparable skills and abilities may substitute for required education
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Founded in 1861, the University of Washington is one of the oldest public institutions in the west coast and one of the preeminent research universities in the world. The University of Washington is a multi-campus university comprised of three different campuses: Seattle, Tacoma, and Bothell. The Seattle campus is made up of sixteen schools and colleges that serve students ranging from an undergraduate level to a doctoral level. The university is home to world-class libraries, arts, music, drama, and sports, as well as the highest quality medical care in Washington State and a world-class academic medical center. The teaching and research of the University’s many professional schools provide undergraduate and graduate students the education necessary toward achieving an excellence that will serve the state, the region, and the nation. As part of a large and diverse community, the University of Washington serves more students than any other institution in the Northwest.