Provider Enrollment Specialist (Hybrid-Remote)

Position Summary

Career Interest : The Provider Enrollment Coordinator is responsible for enrolling and validating practitioners with government and commercial payers.

This position processes provider applications and maintains the enrollment database of provider change.

Responsibilities and Essential Job Functions

• Responsible for all aspects of enrolling, validating, and re-validating practitioners with government and commercial payers.
• Coordinates workflow of all verification of application documents; mailing of initial applications, approval, denial, termination letters, and accurately loading provider information in the enrollment database.
• Processes applications accurately and promptly in accordance with organizational policies and procedures, and health plan requirements.
• Updates database and communicates provider changes to contracted health plans and departments via standardized report(s).
• Coordinates initial and re-enrollment processes. Maintains task grids and tickler systems to assure follow up and completion.
• Maintains communication with practitioner and department management to ensure signature requirements are completed in a timely manner.
• Inputs and modifies enrollment database, which includes performing audits to assure accuracy.
• Responsible for processing the rosters (i.e. additions, changes, and terminations) from physician groups.
• Monitors database performance, and investigates and resolve database questions and concerns. .
• Prepare materials and files necessary to comply with external audits by payers and / or governmental agencies. Maintains ongoing communication with health plan representatives and practitioners.

Performs follow up and complete requests, as necessary.

• Develops, maintains, and provides reports from the department database, and prepares custom reports, data searches and / or data analysis in response to specific requests by internal or external customers
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities.

Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

• High School Graduate or GED.
• 5 or more years of experience as a credentialing specialist or in the area of credentialing.

Preferred Education and Experience

Associates Degree in a related field of study from an accredited college or university.

Preferred Licensure and Certification

• Certified Provider Credentialing Specialist (CPCS) - National Association of Medical Staff Services (NAMSS)
• Certified Professional Medical Services Management (CPMSM) - National Association of Medical Staff Services (NAMSS)

Time Type : Full time

Full time

Job Requisition ID : R-38402

R-38402