Summary:The Provider Enrollment department seeks staff that is committed to the values of compassion, collaboration, innovation, responsibility, diversity, integrity, quality and trust that are integral to our success.

The Provider Enrollment Specialist facilitates the enrollment program and system wide practitioner enrollment for Community Health Services (CHS) and serves as the primary enrollment liaison for clinics, payers, billing office, and practitioner related issues.

Essential Duties and Responsibilities:Include the following. Other duties may be assigned.

• Receives information regarding new practitioners from departments, Medical Staff Office, and billing offices, which includes all mail, email and faxes received from Payers
• Enters practitioner information into enrollment databases such as PECOS and/or various enrollment portals and ensures that the information in the databases is current and accurate.
• Regularly reviews and edits provider CAQH records and verifies that all pertinent elements are captured in the databases and that it matches what is captured in CARE (the Credentialing database).
• Assists Vendor Newport CARE to prepare initial and/or re-enrollment application packets, on behalf of the practitioner, for those payers who require a paper enrollment application.
• Ensures the enrollment packets are appropriately signed, complete and accurate, and submitted to payer with necessary attachments, within Newport CARE system.
• Coordinates re-enrollment dates and sends out application packets for all practitioners who require re-enrollment.
• Tracks all steps taken in enrollment process and logs the actions in Newport CARE (the Credentialing database).
• Monitors the pending credentialing claim report and takes any necessary action (which may include sending additional enrollment applications to the payer) to allow claims to be submitted for payment.
• Completes AO signature tasks in Newport CARE in a timely manner.
• Communicates with various payers, Clinics, billing offices, practitioners, and Division regarding the status of enrollments on an ongoing basis as the primary contact for all enrollment issues.
• Enters payer Provider Identification Numbers (PINs) and the effective date into CARE once they are received.
• Will communicate with Managed Care on an ongoing basis as to status of payer contracts and other various enrollment issues.

Education and/or Experience Preferred: High School diploma or general education degree(GED); 2 years of provider enrollment experience or equivalent combined.

Knowledge: Maintains confidentiality of all provider information and company documents. Speaks clearly and concisely: must have excellent interpersonal and written communication skills: Able to read and interpret written information. Responds promptly in a professional manner to all requests for enrollment documentation and/or questions. Experience with Word, Excel, Outlook, and use of data management systems. Must demonstrate the ability to work independently, resolve issues, solid attention to detail. Ability to adhere to strict deadlines, performance standards and quality measures.

Reasoning Ability:Ability to apply common sense understanding to carry out detailed written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations.

Computer Skills: Strong keyboarding skills and a working knowledge of Microsoft Office (Word / Excel).

Physical Demands:The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this Job, the employee is regularly required to sit; use hands to finger, handle, or feel and talk or hear. The employee is occasionally required to reach with hands and arms and stoop, kneel, crouch, or crawl. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision and ability to adjust focus. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.