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Provider Enrollment Specialist

Harrisburg, PA | Full Time
10 Days Ago

Job Description


Under the direct supervision of the Provider Enrollment Supervisor, the Provider Enrollment Specialist is responsible for maintaining both participating and non-participating provider records in the provider database, mapping claims in the invalid provider queue, resolving provider related issues for claims suspended to Provider Enrollment. Executes the panel transfer process. Completes projects as assigned by Supervisor. Interacts with internal/external clients on provider maintenance activities.

  • Communicates notification of changes to appropriate providers, members and other departments within the contracted time frame.
  • Coordinates the provider mailing for all claims in the invalid provider queue that could not be processed due to missing or invalid information.
  • Researches and resolves returned checks and provider mail.
  • Assists provider and internal customer by responding to and resolving all request and inquiries related to the Panel Transfers, Panel Releases, & Special Needs PCP assignments process.
  • Completes department reports and logs as assigned.
  • Ensures that work is completed according to service level agreements.
  • Attends required training on an annual basis.


  • Associate’s Degree/commensurate work experience.
  • Minimum 1 year related work experience in Heatlhcare.
  • Minimum 4 years’ experience in claims and/or call center.
  • Knowledge of different types of providers, claims process exp preferred.  
  • Customer service experience required.  
  • Software systems including Windows 2000, MS Office, IMAX (external Claims editing).
  • Facets preferred. 
  • Knowledge of Word, Excel and ACCESS is a plus.

Company Overview

  • Website
  • Headquarters PHILADELPHIA, PA
  • Size 3,000 - 7,500
  • Founded 1983
  • Type
  • Revenue $5B - $10B
  • Industry Healthcare
  • About amerihealth caritas health plan
  • At AmeriHealth Caritas, care is the heart of our work. That means that every day we put our members and their families first. We work to improve not only their health, but also the economic and social issues that can act as a barrier to proper care ' the social determinants of health that are estimated to account for 70 percent of avoidable mortality in the U.S. alone. Through our Next Generation Model of Care, we emphasize preventive care, health maintenance, and community outreach programs with a strong focus on ensuring members have access to food, housing, utilities, and other basic necess ... ities. Our mission To help people get care, stay well, and build healthy communities. We have special concern for those who are poor. Our vision Our goal is to develop strategic partnerships and build accessible, flexible health systems across the nation. Moving forward as health care evolves, we will continue to ensure the greatest level of care at maximum value for members, providers, and governments. Ensuring equal access to health care through health equity and health literacy More than 77 million adults have basic or below basic health literacy ' or the ability to understand the basic health services and instructions they receive. Even more can't access the care they need because of social and cultural disparities. Low health literacy costs the U.S. billions of dollars every year and impacts the quality of care millions of Americans receive. In the spirit of our mission, our whole-person model of care leverages Culturally and Linguistically Appropriate Services (CLAS) standards and strong community partnerships. Through community outreach, collaboration with providers and their staff, and 24/7 access to interpretation services, we help to ensure each of our members gets the appropriate, unique care and services they need and deserve. More

Skills for Provider Enrollment Specialist

The job skills required for Provider Enrollment Specialist include Customer Service, provider enrollment etc. Having related job skills and expertise will give you an advantage when applying to be a Provider Enrollment Specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Provider Enrollment Specialist. Select any job title you are interested in and start to search job requirements.

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Career Path for Provider Enrollment Specialist

The following is the career advancement route for Provider Enrollment Specialist positions, which can be used as a reference in future career path planning. As a Provider Enrollment Specialist, it can be promoted into senior positions as an Enrollment and Billing Supervisor that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Provider Enrollment Specialist. You can explore the career advancement for a Provider Enrollment Specialist below and select your interested title to get hiring information.