Provider Enrollment Specialist

Job Description

REQUIREMENTS

• High school diploma or equivalent required, associate or Bachelor’s degree preferred.
• 1- 3 years of experience in payor enrollment.
• Working knowledge of commercial payors and government payor requirements.
• Proficient in Microsoft office and credentialing software including but not limited to CAQH, Availity.
• Strong attention to detail, organization and follow up skills.
• Excellent communication and customer service abilities interacting with internal teammates and external clients.
• Detail oriented, with strong level of analytical and problem-solving skills.

Preferred Skills:

• Experience in working with multi-specialty large group practices; dentistry is a plus.
• Knowledge of revenue cycle and billing processes.
• Familiarity with NPI and file provider management.

RESPONSIBILITIES

• Prepare, submit and track payer enrollment applications for new providers and existing provider changes.
• Maintain accurate records of all enrollment activities in the credentialing system.
• Communicate with insurance companies, healthcare providers and internal departments to ensure applications are processed efficiently.
• Monitor enrollment status and follow up with payers to resolve delays or issues.
• Update provider demographic and practice information with all contract payers as needed.
• Ensure recredentialing timelines and requirements are maintained so providers enrollment status remains intact with no lapses.
• Work closely with Field Support, Operations, Revenue Cycle Management (RCM) team to resolve any escalated enrollment or credentialing issues in a timely manner.
• Research and resolve out of network claims issues by investigating provider participation status and effective dates of enrollment.
• Coordinate temporary provider enrollments and ensure all necessary documentation, linkage and payer updates are completed.
• Collaborate closely with RCM on status of provider enrollments including providing reports submission as needed.
• Generate and maintain enrollment status reports.
• Support audits, and other duties as assigned.

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