Provider Enrollment Specialist

Job Overview

The primary function of a Provider Enrollment Specialist is to perform enrollment and re-enrollment related functions for providers with contracted insurance carriers and government payers, as needed. This position serves as a resource and liaison to implement and resolve issues related to enrollment credentialing. This position will work directly with our payer contacts as well as our employed physicians to ensure all applications are completed within specified time periods.

Duties

• Maintains and updates accurate data in most current credentialing software.
• Understands and maintains current knowledge of state and federal regulatory requirements, payer credentialing standards, and other accreditation standards as they apply to credentialing.
• Responsible for government and managed care credentialing and recredentialing of employed practitioners in our owned practices –Duties include distribution of credentialing packet, completion of application/documentation submission, and required follow-up in compliance with legal, accreditation, and regulatory requirements.
• Responsible for demographic change notification to Payors for employed practitioners in owned practices
• Maintains public relation skills in a wide variety of phone contacts and written communications with external sources for purposes of gathering information essential to credentials verifications, including licensing agencies, certification boards, insurance carriers, hospital officials, physicians, and their office staff.
• Presents updated statuses of open issues at monthly meetings.

Education & Experience

• Bachelor’s degree from an accredited college or a minimum of four years’ experience working in managed care, credentialing, or revenue cycle.
• Minimum 1-2 years of applicable experience.

Required Experience:

• Online Payor Portals
• Medicare and Medicaid
• MS Office Suite
• CAQH
• NCTracks
• Symplr Provider Enrollment Platform

Benefits:

• AD&D insurance
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Tuition reimbursement
• Vision insurance