DMEPOS Provider Enrollment Specialist

Qlarant is a not-for-profit corporation that partners with public and private sectors to create high quality, safe, and efficient delivery of health care and human services programs. We have multiple lines of business including population health, utilization review, managed care organization quality review, and quality assurance for programs serving individuals with developmental disabilities. Qlarant is also a national leader in fighting fraud, waste and abuse for large organizations across the country. In addition, our Foundation provides grant opportunities to those with programs for under-served communities.

The Provider Enrollment Specialist coordinates a variety of administrative/clerical/technical work for Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) provider enrollment and anti-fraud functions related to adverse legal actions, revocations and corrective action plans.  This position is a home-based position for a well-qualified candidate.  We offer an inclusive and supportive work environment, opportunities for advancement and a complete benefits package that includes health, dental, vision, two retirement plans and generous vacation, sick and holiday leave.

Essential Duties and Responsibilities:

·         Perform reviews of Adverse Legal Actions (ALA) by reviewing documentation submitted with initial and change applications.

·         Take revocation actions against suppliers who no longer meet all required supplier standards such as accreditation, surety bonding, special licensing, etc.

·         Evaluate Corrective Action Plans associated with revocation actions

·         Process revocations at the request of CMS and/or the UPIC

·         Respond to complex inquiries with clearly written correspondence and/or verbal responses

·         Meet processing timeliness expectations as defined in the PIM or other CMS instructions

·         Assist with provider enrollment clean-up activities and other special projects as requested by CMS

• Enter investigative information into the case tracking systems and/or PECOS and meet with Lead Investigator(s) to evaluate anti-fraud related activities or DMEPOS provider enrollment, corrective action plans (CAP), adverse legal actions (ALA).
• Works with the team to prioritize workload for provider enrollment records. 

·         Analyzes and takes actions for suppliers not meeting standards such as DMEPOS accreditation, surety bond requirements, licensing, etc. for appropriateness, timeliness issues in accordance with pre-established criteria, requesting additional documentation if necessary.

·         Refers all potential adverse decisions timely and coordinates with the Lead Investigator/Manager.

·         Identifies, collects, preserves, analyzes and summarizes evidence, examining records, verifying authenticity of documents, preparing affidavits or supervising the preparation of affidavits as needed.

·         Drafts and evaluates required reports and promotes effective and efficient analysis as needed.

·         Initiates and maintains communications with law enforcement and appropriate regulatory agencies including presenting case findings for their consideration to further investigate, prosecute, or seek other appropriate regulatory or administrative remedies. 

·         Communicates with suppliers and providers as needed to resolve beneficiary complaints and assists providers with provider enrollment. 

·         Coordinates input for PECOS, CMSARTs system and/or other systems required per contract.

·         Writes reports, prepares presentations, and ensures the timely approval by Program Director of deliverables.

·         Identifies opportunities to improve processes and procedures.

To perform the job successfully, an individual should demonstrate the following competencies:

·         Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data.

·         Problem Solving – Gathers and analyses information skillfully; Identifies and resolves problems.

·         Written Communication - Writes clearly and informatively; Able to read and interpret written information.

·         Judgment - Supports and explains reasoning for decisions.

Required:

·       High School Diploma or GED with minimum of one year of Medicare and Medicaid Revocations and DMEPOS related work experience required.

Preferred:

·       Medicare and DMEPOS provider enrollment experience.

·       Experience using CMS PECOS,.

·       Working knowledge of CMS DMEPOS surety bond, accreditation, licensing, site visits and supplier standards requirements.

·       Working knowledge of Corrective Action Plan (CAP) and Adverse Legal Action (ALA)

·       Intermediate level proficiency in Microsoft Office to include Word, Excel and Outlook.

Qlarant, Inc is an Equal Opportunity Employer of Minorities, Females, Protected Veterans, and Individuals with Disabilities.