What are the responsibilities and job description for the Provider Enrollment Specialist position at Arkansas Children's?
ARKANSAS CHILDREN'S IS A TOBACCO FREE WORKPLACE. FLU VACCINES ARE REQUIRED. ARKANSAS CHILDREN'S IS AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION FOR EMPLOYMENT WITHOUT REGARD TO RACE, COLOR, RELIGION, SEX, SEXUAL ORIENTATION, GENDER IDENTITY OR EXPRESSION, NATIONAL ORIGIN, AGE, DISABILITY, PROTECTED VETERAN STATUS OR ANY OTHER CHARACTERISTIC PROTECTED BY FEDERAL, STATE, OR LOCAL LAWS.
This position has been designated as safety sensitive and cannot be filled by a candidate who is a current user of medical marijuana.
CURRENT EMPLOYEES: Please apply via the internal career site by logging into your Workday Account (https://www.myworkday.com/archildrens/)and search the "Find Jobs" report.
Work Shift:
Day Shift
Time Type:
Full time
Department:
CC017690 Managed Care
Summary:
Monday through Friday, full-time hybrid position. There will be two weeks of training onsite.
Additional Information:
The Provider Enrollment Specialist facilitates the applications from a new/existing provider’s through all stages in order to enroll or re-validate the provider’s with commercial and/or government payers as well as facilities. The Specialist is also responsible for updating practitioner information in both the internal software and with external payers. In addition to data entry, the specialist also maintains copies of licensure, certificates, and other documents necessary for the enrollment process, maintains provider CAQH profiles, and conducts verification of all data, ensuring accuracy and timely entry of information. The specialist shares essential updates with providers and the internal team as necessary in weekly summary reports. Decisions will have a direct impact upon the efficiency and effectiveness of Enrollment and upon direct staff. Decisions also have the potential to impact PHO rosters, COM departments and Billing Services. Must function fairly independently with a strong awareness of the interactions and interdependency of all areas
Required Education:
High school diploma or GED or equivalent
Recommended Education:
Bachelor's degree in a related field of study.
Required Work Experience:
High School Diploma/GED, or 2 years of experience in lieu of a diploma/GED.
Recommended Work Experience:
Required Certifications:
Recommended Certifications:
Description
This position has been designated as safety sensitive and cannot be filled by a candidate who is a current user of medical marijuana.
CURRENT EMPLOYEES: Please apply via the internal career site by logging into your Workday Account (https://www.myworkday.com/archildrens/)and search the "Find Jobs" report.
Work Shift:
Day Shift
Time Type:
Full time
Department:
CC017690 Managed Care
Summary:
Monday through Friday, full-time hybrid position. There will be two weeks of training onsite.
Additional Information:
The Provider Enrollment Specialist facilitates the applications from a new/existing provider’s through all stages in order to enroll or re-validate the provider’s with commercial and/or government payers as well as facilities. The Specialist is also responsible for updating practitioner information in both the internal software and with external payers. In addition to data entry, the specialist also maintains copies of licensure, certificates, and other documents necessary for the enrollment process, maintains provider CAQH profiles, and conducts verification of all data, ensuring accuracy and timely entry of information. The specialist shares essential updates with providers and the internal team as necessary in weekly summary reports. Decisions will have a direct impact upon the efficiency and effectiveness of Enrollment and upon direct staff. Decisions also have the potential to impact PHO rosters, COM departments and Billing Services. Must function fairly independently with a strong awareness of the interactions and interdependency of all areas
Required Education:
High school diploma or GED or equivalent
Recommended Education:
Bachelor's degree in a related field of study.
Required Work Experience:
High School Diploma/GED, or 2 years of experience in lieu of a diploma/GED.
Recommended Work Experience:
Required Certifications:
Recommended Certifications:
Description
- Conducts the enrollment process and maintains provider information in MD Staff platform
- Adheres to deadlines and enrollment schedules by tracking files through all stages
- Communicates with providers, payers, MSOs via email, phone, Teams and mail
- Helps the department move to paperless by centralizing all provider data gathered in software
- Maintains confidentiality and responsibility for all enrollment files through the process
- Maintain an organized database of physician information, ensuring accuracy and completeness.
- Ensure that all enrollment activities adhere to healthcare regulations and organizational policies.
- Collaborate with internal departments, including HR, legal, and billing, to facilitate the enrollment process.
- Address and resolve enrollment-related issues and discrepancies promptly. Monitor and meet goals established for KPI metrics
- Generate reports and documentation related to physician enrollment, as needed. Maintaining work ques for provider enrollment within HIS system.
- Other duties as assigned.