Provider Enrollment Specialist

Job Description

Job Description

Overview

As a Provider Enrollment Specialist, you'll be responsible for assisting with the administration of the provider enrollment process for assigned new and existing providers. You'll also be responsible for assisting in obtaining and maintaining information essential to complete the credentialing/re-credentialing process.

Responsibilities

• Prepares and submits enrollment applications for practitioners/group practices and facilities
• Initiates and manages new enrollments until providers are enrolled with all assigned payers
• Follows up on the status of enrollment applications as well as maintaining all updated needed using Smart Sheets
• Using Smart Sheets, keeps detailed log of all pending and completed tasks
• Maintains/Updates/Communicates enrollment status reports and updates on regular basis
• Maintains/updates Wybtrak/CAQH and other provider portals on regular basis
• Maintains managed care insurance paperless files for assigned practitioners
• Frequently contacts practitioners, insurance representatives and other provider staff for compilation of provider data
• Complies with NCQA, Medicare and Medicaid standards, department procedures and guidelines
• Maintains strict confidentiality, adheres to all HIPAA Guidelines/Regulations
• Familiar with Medicare, Medicaid, commercial fee schedules; assist Director in updating fee schedules for updates to Next Gen EPM
• Works effectively and proactively to resolve issues
• Performs all other duties as assigned

Qualifications

• High School Diploma or equivalent
• Associate's Degree preferred or - 2 years of office business experience in lieu of Associate Degree
• Provider Enrollment Specialist Certificate (PESC) or Certified Provider Credentialing Specialist (CPCS) or similar certification in credentialing, health plan or network management required

• 2 – 3 years’ experience in Provider Enrollment and Credentialing fields is required for this position

• Must have working knowledge in Managed Care and/or Network Management

• Proficiency in MS applications including and not limited to credentialing database software
• Strong organizational skills and ability to pay attention to detail
• Excellent communication skills and problem solving abilities within a team environment
• Ability to work independently and prioritize assigned duties within given time frames
• Ability to establish and maintain effective working relationships with insurance representatives, providers and coworkers